Healthcare Provider Details

I. General information

NPI: 1790168110
Provider Name (Legal Business Name): RISHABH GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W JANSS RD
THOUSAND OAKS CA
91360-1848
US

IV. Provider business mailing address

215 W JANSS RD
THOUSAND OAKS CA
91360-1847
US

V. Phone/Fax

Practice location:
  • Phone: 805-852-9100
  • Fax:
Mailing address:
  • Phone: 805-852-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301107238
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC208563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: