Healthcare Provider Details

I. General information

NPI: 1104204080
Provider Name (Legal Business Name): GUPTA HEART AND VASCULAR CENTER OF LAS VEGAS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10170 W TROPICANA AVE # 156-306
LAS VEGAS NV
89147-8465
US

IV. Provider business mailing address

10170 W TROPICANA AVE # 156-306
LAS VEGAS NV
89147-8465
US

V. Phone/Fax

Practice location:
  • Phone: 702-321-1513
  • Fax:
Mailing address:
  • Phone: 702-321-1513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MANISH P GUPTA
Title or Position: CEO
Credential: M.D
Phone: 702-321-1513