MEDICARE: DR. ABHA S GUPTA M.D.

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	174400000X	Specialist	A41163	CA

General Provider Information

NPI Number	:	1336140458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABHA S GUPTA M.D.

Provider Business Mailing Address
First Line	:	801 N TUSTIN AVE
Second Line	:	# 201
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3612
Country	:	US
Telephone Number	:	714-558-7277
Fax Number	:	714-558-3075

Provider Business Practice Location Address
First Line	:	801 N TUSTIN AVE
Second Line	:	# 201
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3612
Country	:	US
Telephone Number	:	714-558-7277
Fax Number	:	714-558-3075

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	02/21/2012

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