Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1235327255 |
---|---|
Provider Name | Sanjay K Gupta |
First Address | Northridge, CA 91324-4628 |
Second Address | Northridge, CA 91324-4628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2007 |
Last Update Date | 04/10/2007 |