MEDICARE: DR. AMAR 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	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	A167029	CA
2	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	A167029	CA

General Provider Information

NPI Number	:	1912340159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMAR GUPTA M.D.

Provider Business Mailing Address
First Line	:	6850 BROCKTON AVE STE 108
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3814
Country	:	US
Telephone Number	:	951-313-6843
Fax Number	:	951-800-1850

Provider Business Practice Location Address
First Line	:	6850 BROCKTON AVE STE 108
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3814
Country	:	US
Telephone Number	:	951-313-6843
Fax Number	:	951-800-1850

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

Provider Enumeration Date	:	04/08/2013
Last Update Date	:	08/30/2021

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