MEDICARE: DR. RACHNA GUPTA D.O.

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	207W00000X	Ophthalmology Physician	1234	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538137401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHNA GUPTA D.O.

Provider Business Mailing Address
First Line	:	1459 DANYELLE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1300
Country	:	US
Telephone Number	:	702-307-5227
Fax Number	:	702-307-5227

Provider Business Practice Location Address
First Line	:	765 N NELLIS BLVD
Second Line	:	SUITE 6
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-5391
Country	:	US
Telephone Number	:	702-791-3931
Fax Number	:	702-791-3936

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	11/14/2014

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