Basic Information
| Provider Information | |||||||||
| NPI: | 1811901580 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUPTA | ||||||||
| FirstName: | LEENA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4945 BRIDGEVIEW LN | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951382702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4086660392 | ||||||||
| FaxNumber: | 6019845503 | ||||||||
| Practice Location | |||||||||
| Address1: | 5189 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | MARIPOSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953389524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2099663631 | ||||||||
| FaxNumber: | 2099663776 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 06/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084A2900X | 26851 | MS | N | 207R00000X | MD00042605 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | A98907 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.