Provider Demographics
NPI:1013119767
Name:RACHNA GUPTA, D.O., P.C.
Entity Type:Organization
Organization Name:RACHNA GUPTA, D.O., P.C.
Other - Org Name:DESERT EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RACHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-791-3931
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:702-791-3931
Mailing Address - Fax:
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:89110-5311
Practice Address - Country:US
Practice Address - Phone:702-791-3931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1234207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507191Medicaid
NV100507191Medicaid