Provider Demographics
NPI:1952862542
Name:GUPTA, PERVIN N/A
Entity Type:Individual
Prefix:
First Name:PERVIN
Middle Name:N/A
Last Name:GUPTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PERVIN
Other - Middle Name:
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2535 BINARY STARS ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-4427
Mailing Address - Country:US
Mailing Address - Phone:702-990-1094
Mailing Address - Fax:
Practice Address - Street 1:2535 BINARY STARS ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-4427
Practice Address - Country:US
Practice Address - Phone:702-990-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health