Healthcare Provider Details

I. General information

NPI: 1548587306
Provider Name (Legal Business Name): RAVI K GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28881 AIROSO ST UNIT 110
RANCHO MISSION VIEJO CA
92694-2487
US

IV. Provider business mailing address

PO BOX 280
RANCHO MIRAGE CA
92270-0280
US

V. Phone/Fax

Practice location:
  • Phone: 949-682-2600
  • Fax:
Mailing address:
  • Phone: 760-837-8449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA120602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: