Individual ProviderMitalie GuptaInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address6044 Gateway Blvd E Fl 9, El Paso, TX 79905-2023(915) 521-1474(915) 521-1471PECOS EnrollmentBased on the most recent information from CMS, provider Mitalie Gupta is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1164050472Provider TypeIndividualFull NameGupta, MitalieTitleDr.CredentialMDGenderFemaleSole ProprietorNoEnumeration Date3/31/2020Last Updated1/9/2024Contact InformationPractice LocationPractice Address6044 Gateway Blvd E Fl 9, El Paso, TX 79905-2023Phone(915) 521-1474FaxUnlisted FaxMailing LocationMailing Address6044 Gateway Blvd E Fl 9, El Paso, TX 79905-2023Phone(915) 521-1471FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseU8063TexasCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerCode209800000XDescriptionLegal MedicineAllopathic & Osteopathic PhysiciansLicenseMD2023-1530New Mexico