Provider Demographics
NPI:1174754428
Name:GUPTA, ANTOINETTE (ANTOINETTE GUPTA MS)
Entity type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:ANTOINETTE GUPTA MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 BARRANCA PKWY
Mailing Address - Street 2:SUITE 252
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4711
Mailing Address - Country:US
Mailing Address - Phone:949-954-0750
Mailing Address - Fax:
Practice Address - Street 1:4010 BARRANCA PKWY
Practice Address - Street 2:SUITE 252
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4711
Practice Address - Country:US
Practice Address - Phone:949-954-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49403106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist