Provider Demographics
NPI:1538137401
Name:GUPTA, RACHNA (DO)
Entity type:Individual
Prefix:DR
First Name:RACHNA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RACHNA
Other - Middle Name:
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1459 DANYELLE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1300
Mailing Address - Country:US
Mailing Address - Phone:702-307-5227
Mailing Address - Fax:702-307-5227
Practice Address - Street 1:765 N NELLIS BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5391
Practice Address - Country:US
Practice Address - Phone:702-791-3931
Practice Address - Fax:702-791-3936
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1234207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507191Medicaid
NVI50415Medicare UPIN