Doctor Name: | DR. MAMTA GUPTA |
NPI Number: | 1003007022 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | |
Business Practice Address: | 3600 Gaston Ave Suite 550 Dallas, TX - 752461800 |
Business Phone Number: | 2148218867 |
Business Fax Number: | 2148211193 |
Mailing Address: | 1352 Valley Vista Dr, IRVING |
State: | TX |
Postal Code: | 750634310 |
Phone Number: | 2144789416 |
Fax Number: | 9725562350 |
NPI Enumeration Date: | 08/06/2007 |
NPI Last Update Date: | 03/30/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |