Individual
DR. SAURABH GUPTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3990 OLD TOWN AVE, STE. A-208, SAN DIEGO, CA 92110-2930
(619) 537-9345
(619) 269-9245
Mailing address
3990 OLD TOWN AVE, STE. A-208, SAN DIEGO, CA 92110-2930
(619) 537-9345
(619) 269-9245
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY24218
CA
103T00000X
Psychologist
PSY24218
CA
103TC0700X
Clinical Psychologist
PSY24218
CA
103TC1900X
Counseling Psychologist
PSY24218
CA
103TF0200X
Forensic Psychologist
PSY24218
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12258947
CAQH
—
Enumeration date
06/20/2011
Last updated
08/08/2012
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