Provider Demographics
NPI:1922364868
Name:GUPTA, ROHAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ROHAN
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 AUTUMN HILL LN
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-6016
Mailing Address - Country:US
Mailing Address - Phone:949-394-1248
Mailing Address - Fax:
Practice Address - Street 1:16631 NOYES AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5138
Practice Address - Country:US
Practice Address - Phone:949-252-9946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12285225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist