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General NPI Number Information
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NPI Number | 1831125624
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Entity Type | Individual
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Provider Name | INDU GUPTA M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 4125 BANGS AVE
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City | MODESTO
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State | CA
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Zip | 95356-8713
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Country | US
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Telephone | 209-557-1722
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Fax | 209-557-1685
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Provider Business Mailing Address
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Address Line | 2801 BRADEN AVE APT 349
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City | MODESTO
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State | CA
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Zip | 95356-0645
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Country | US
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Telephone | 513-295-4670
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Fax | 209-557-1685
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | 35-08-2875
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License Number State | OH
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