Healthcare Provider Details

I. General information

NPI: 1144285552
Provider Name (Legal Business Name): ANURAG GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 S RAINBOW BLVD STE 100
LAS VEGAS NV
89146-6217
US

IV. Provider business mailing address

3245 S RAINBOW BLVD STE 100
LAS VEGAS NV
89146-6217
US

V. Phone/Fax

Practice location:
  • Phone: 702-228-4900
  • Fax: 702-228-1177
Mailing address:
  • Phone: 702-228-4900
  • Fax: 702-228-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12572
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: