Provider Demographics
NPI:1386972537
Name:ABHA GUPTA M D A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ABHA GUPTA M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-558-7277
Mailing Address - Street 1:801 N TUSTIN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3600
Mailing Address - Country:US
Mailing Address - Phone:714-558-7277
Mailing Address - Fax:714-558-3075
Practice Address - Street 1:801 N TUSTIN AVE STE 201
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3600
Practice Address - Country:US
Practice Address - Phone:714-558-7277
Practice Address - Fax:714-558-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41163261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center