MEDICARE: DR. ANITA GUPTA

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	207L00000X	Anesthesiology Physician	173723	CA
2	207L00000X	Anesthesiology Physician	DO034234	DC
3	207L00000X	Anesthesiology Physician	25MB08924000	NJ
4	207LP2900X	Pain Medicine (Anesthesiology) Physician	25MB08924000	NJ
5	207LP2900X	Pain Medicine (Anesthesiology) Physician	DO034234	DC
6	207LP2900X	Pain Medicine (Anesthesiology) Physician	173723	CA

General Provider Information

NPI Number	:	1376746834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANITA GUPTA

Provider Business Mailing Address
First Line	:	122 15TH ST UNIT 400
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-8017
Country	:	US
Telephone Number	:	844-213-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	12843 EL CAMINO REAL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2964
Country	:	US
Telephone Number	:	844-213-7246
Fax Number	:

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

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	08/17/2024

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Directions to “ DR. ANITA GUPTA ” Practice Location

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