Provider Demographics
NPI:1366420416
Name:NAVEEN GUPTA MD INC
Entity type:Organization
Organization Name:NAVEEN GUPTA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-946-6792
Mailing Address - Street 1:360 E 7TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6701
Mailing Address - Country:US
Mailing Address - Phone:909-946-6792
Mailing Address - Fax:909-949-1172
Practice Address - Street 1:360 E 7TH ST
Practice Address - Street 2:STE B
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6701
Practice Address - Country:US
Practice Address - Phone:909-946-6792
Practice Address - Fax:909-949-1172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-07
Last Update Date:2010-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34794207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110035556OtherRAILROAD
CA00A347940Medicaid
CA110035556OtherRAILROAD
CAZZZ05846ZMedicare PIN