Provider Demographics
NPI:1366455784
Name:GUPTA, RAHUL (MD)
Entity Type:Individual
Prefix:
First Name:RAHUL
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 JAMIE DR
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-1183
Mailing Address - Country:US
Mailing Address - Phone:530-821-0470
Mailing Address - Fax:
Practice Address - Street 1:945 SHASTA ST
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4114
Practice Address - Country:US
Practice Address - Phone:530-674-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL36712085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C522970Medicaid
P00385673OtherMEDICARE ID
P00385676OtherMEDICARE ID
CA00C522970Medicaid
P00385676OtherMEDICARE ID