Basic Information
| Provider Information | |||||||||
| NPI: | 1306953104 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUPTA | ||||||||
| FirstName: | SACHIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4411 MEDICAL DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106145400 | ||||||||
| FaxNumber: | 2106144244 | ||||||||
| Practice Location | |||||||||
| Address1: | 4411 MEDICAL DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106145400 | ||||||||
| FaxNumber: | 2106142413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 02/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | M4799 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RA0001X | M4799 | TX | Y |
ID Information
| ID | Type | State | Issuer | Description | 183787407 | 01 | TX | MEDICAID - TARRANT | OTHER | 329768YNGS | 01 | TX | MEDICARE - TARRANT | OTHER | 183787406 | 01 | TX | MEDICAID - OTHER | OTHER | 329768YL7A | 01 | TX | MEDICARE - OTHER | OTHER | 183787405 | 05 | TX | MEDICAID |