1598806390 NPI number — DR. VINEET GUPTA M.D.

Table of content: DR. VINEET GUPTA M.D. (NPI 1598806390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598806390 NPI number — DR. VINEET GUPTA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUPTA
Provider First Name:
VINEET
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598806390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
481 PLUMAS BLVD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
YUBA CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95991-5075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-674-2434
Provider Business Mailing Address Fax Number:
530-674-2704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
481 PLUMAS BLVD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
YUBA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95991-5075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-674-2434
Provider Business Practice Location Address Fax Number:
530-674-2704
Provider Enumeration Date:
02/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A96761 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00773706 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A967610 . This is a "BLUE SHIELD PIN #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BY113Y . This is a "MEDICARE PTAN - RIDEOUT MEMORIAL HOSPITAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BY113Z . This is a "MEDICARE PTAN - YUBA CITY PRIMARY CARE AND DIABETES 2 CLINIC, INC." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1598806390 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".