Healthcare Provider Details

I. General information

NPI: 1013014224
Provider Name (Legal Business Name): GUPTA HEADACHE & PAIN INSTITUTE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4407 BEE CAVE RD SUITE 211
WEST LAKE HILLS TX
78746-6405
US

IV. Provider business mailing address

4407 BEE CAVE RD SUITE 211
WEST LAKE HILLS TX
78746-6405
US

V. Phone/Fax

Practice location:
  • Phone: 512-330-0961
  • Fax: 512-330-0962
Mailing address:
  • Phone: 512-330-0961
  • Fax: 512-330-0962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberK0794
License Number StateTX

VIII. Authorized Official

Name: DR. RAJAT GUPTA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 512-330-0961