Provider Demographics
NPI:1942620869
Name:GUPTA, RISHU (MD)
Entity Type:Individual
Prefix:
First Name:RISHU
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 1:2023 W VISTA WAY STE D
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6030
Mailing Address - Country:US
Mailing Address - Phone:858-357-7033
Mailing Address - Fax:
Practice Address - Street 1:2023 W VISTA WAY STE D
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6030
Practice Address - Country:US
Practice Address - Phone:858-357-7033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015014060207N00000X
CAA153840207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology