Healthcare Provider Details

I. General information

NPI: 1912468299
Provider Name (Legal Business Name): RAHAEL ROHINI GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 CORDOVA ST
PASADENA CA
91101-2552
US

IV. Provider business mailing address

525 CORDOVA ST
PASADENA CA
91101-2552
US

V. Phone/Fax

Practice location:
  • Phone: 818-643-5083
  • Fax:
Mailing address:
  • Phone: 818-643-5083
  • Fax: 818-643-7098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberPTL1300
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA181810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: