Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A167029 | CA |
NPI | 1912340159 |
---|---|
Provider Name | Dr. Amar Gupta |
First Address | Riverside, CA 92506-3814 |
Second Address | Riverside, CA 92506-3814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2013 |
Last Update Date | 30/08/2021 |