=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013119767
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RACHNA GUPTA, D.O., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2007
-----------------------------------------------------
Last Update Date | 11/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 765 N NELLIS BLVD SUITE 6
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89110-5311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-791-3931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1459 DANYELLE CT
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89117-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-791-3931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RACHNA GUPTA
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 702-791-3931
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 1234
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------