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General NPI Number Information
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NPI Number | 1992524672
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Entity Type | Organization
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Legal Business Name | SANSA MED SPA LLC
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 505 W HOLLIS ST STE 211
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City | NASHUA
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State | NH
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Zip | 03062-1388
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Country | US
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Telephone | 978-245-5885
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Fax |
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Provider Business Mailing Address
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Address Line | 505 W HOLLIS ST STE 211
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City | NASHUA
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State | NH
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Zip | 03062-1388
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Country | US
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Telephone | 978-245-5885
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SANJAY GUPTA
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Credential | MD
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Telephone | 207-576-3296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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