Basic Information
| Provider Information | |||||||||
| NPI: | 1851615520 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUPTA | ||||||||
| FirstName: | RESHMA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10945 LE CONTE AVE | ||||||||
| Address2: | SUITE 1401, UEBERROTH BUILDING | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900953000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102068687 | ||||||||
| FaxNumber: | 3102067975 | ||||||||
| Practice Location | |||||||||
| Address1: | 4860 Y ST STE 1600 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167342737 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2010 | ||||||||
| LastUpdateDate: | 10/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD60340270 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | A128870 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1851615520 | 05 | WA | MEDICAID |