MEDICARE: MR. RAJEEV GUPTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A49489	CA
2	208000000X	Pediatrics Physician	A49489	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	WA49489F	OTHER	CA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110152471	OTHER	CA	RAILROAD PIN
3	ZZZ47481Z	OTHER	CA	BLUE SHIELD OF CALIFORNIA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	GR0066312	OTHER	CA	MEDI CAL GROUP NUMBER
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437117959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAJEEV GUPTA MD

Provider Business Mailing Address
First Line	:	516 WEST ATEN ROAD
Second Line	:	SUITE 2
City	:	IMPERIAL
State	:	CA
Zip	:	92251
Country	:	US
Telephone Number	:	760-355-7730
Fax Number	:	760-355-7731

Provider Business Practice Location Address
First Line	:	1550 N IMPERIAL AVE
Second Line	:	SUITE 1
City	:	EL CENTRO
State	:	CA
Zip	:	92243-6304
Country	:	US
Telephone Number	:	760-352-1731
Fax Number	:	760-337-1834

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	06/18/2008

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Directions to “ MR. RAJEEV GUPTA MD” Practice Location

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