Healthcare Provider Details

I. General information

NPI: 1194809111
Provider Name (Legal Business Name): NALINI GUPTA MBBS,DCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N RIVERPOINT BLVD
SPOKANE WA
99202-1610
US

IV. Provider business mailing address

412 E SPOKANE FALLS BLVD # 1495
SPOKANE WA
99202-2131
US

V. Phone/Fax

Practice location:
  • Phone: 509-505-7481
  • Fax: 509-606-2515
Mailing address:
  • Phone: 509-990-5900
  • Fax: 509-606-2515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number050019
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberMD60095203
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60095203
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: