MEDICARE: DR. NAVEEN GUPTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	A81440	CA
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	A81440	CA

General Provider Information

NPI Number	:	1013015569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAVEEN GUPTA MD

Provider Business Mailing Address
First Line	:	FILE 57326
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-7326
Country	:	US
Telephone Number	:	800-926-8273
Fax Number	:

Provider Business Practice Location Address
First Line	:	4520 EXECUTIVE DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3018
Country	:	US
Telephone Number	:	800-926-8273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	06/26/2024

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