Provider Demographics
NPI:1457365512
Name:BHARGAVA-GUPTA, RADHA (MD)
Entity Type:Individual
Prefix:DR
First Name:RADHA
Middle Name:
Last Name:BHARGAVA-GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 E WALNUT ST
Mailing Address - Street 2:3 RD FLOOR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91188-0001
Mailing Address - Country:US
Mailing Address - Phone:626-405-3147
Mailing Address - Fax:626-405-5507
Practice Address - Street 1:393 E WALNUT ST
Practice Address - Street 2:3 RD FLOOR
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91188-0001
Practice Address - Country:US
Practice Address - Phone:626-405-3147
Practice Address - Fax:626-405-5507
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72480207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A724800Medicaid
CA00A724800Medicaid
CAH98698Medicare UPIN