Provider Demographics
NPI:1912468299
Name:GUPTA, RAHAEL ROHINI (MD)
Entity type:Individual
Prefix:
First Name:RAHAEL
Middle Name:ROHINI
Last Name: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 1:525 CORDOVA ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2552
Mailing Address - Country:US
Mailing Address - Phone:818-643-5083
Mailing Address - Fax:818-643-7098
Practice Address - Street 1:525 CORDOVA ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2552
Practice Address - Country:US
Practice Address - Phone:818-643-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTL13002084P0800X, 2084P0800X
CAA1818102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry