Healthcare Provider Details

I. General information

NPI: 1356925960
Provider Name (Legal Business Name): MOUNTAIN VIEW HEADACHE AND SPINE INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4729 E UNION HILLS DR SUITE 111
PHOENIX AZ
85050-3390
US

IV. Provider business mailing address

4729 E UNION HILLS DR SUITE 111
PHOENIX AZ
85050-3390
US

V. Phone/Fax

Practice location:
  • Phone: 602-767-0007
  • Fax:
Mailing address:
  • Phone: 602-767-0007
  • Fax: 602-767-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RUCHIR GUPTA
Title or Position: OWNER / CEO
Credential: MD
Phone: 917-443-1263