Healthcare Provider Details

I. General information

NPI: 1912313263
Provider Name (Legal Business Name): KARANVIR GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 12/01/2024
Certification Date: 12/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 N PECOS RD STE 120
HENDERSON NV
89074-1918
US

IV. Provider business mailing address

283 N PECOS RD STE 120
HENDERSON NV
89074-1918
US

V. Phone/Fax

Practice location:
  • Phone: 702-357-5814
  • Fax: 886-739-9251
Mailing address:
  • Phone: 702-357-5814
  • Fax: 886-739-9251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRL13320
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17418
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: