Individual
AMITA GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2075 W PECOS RD, #2, CHANDLER, AZ 85224-5693
(480) 219-6840
(480) 219-6841
Mailing address
2075 W PECOS RD, SUITE 2, CHANDLER, AZ 85224-5722
(480) 219-6840
(480) 219-6841
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
33008
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
866973
—
AZ
01
—
AZ0759120
BC/BS OF AZ
AZ
01
—
P00279971
RR MEDICARE
AZ
Enumeration date
03/25/2006
Last updated
10/10/2011
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