Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | E4605 | CA |
N | 213ES0103X | Foot & Ankle Surgery | E4605 | CA |
NPI | 1437112620 |
---|---|
Provider Name | Deepshikha Gupta-Schunck |
First Address | Modesto, CA 95355-4201 |
Second Address | Stockton, CA 95209-2839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 27/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V06612 | (02) | CA |