MEDICARE: PREETI 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	208000000X	Pediatrics Physician	V7221	TX
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1417698341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PREETI GUPTA

Provider Business Mailing Address
First Line	:	11930 W US HIGHWAY 90 STE 110
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-9613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11930 W US HIGHWAY 90 STE 110
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-9613
Country	:	US
Telephone Number	:	210-431-6255
Fax Number	:

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

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	08/27/2025

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Directions to “ PREETI GUPTA ” Practice Location

Language	Start Address	Practice Location

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