Healthcare Provider Details

I. General information

NPI: 1538137401
Provider Name (Legal Business Name): RACHNA GUPTA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHNA GUPTA D.O.

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 N NELLIS BLVD SUITE 6
LAS VEGAS NV
89110-5391
US

IV. Provider business mailing address

1459 DANYELLE CT
LAS VEGAS NV
89117-1300
US

V. Phone/Fax

Practice location:
  • Phone: 702-791-3931
  • Fax: 702-791-3936
Mailing address:
  • Phone: 702-307-5227
  • Fax: 702-307-5227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1234
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: