Basic Information
| Provider Information | |||||||||
| NPI: | 1073566261 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUPTA | ||||||||
| FirstName: | NIRAJ | ||||||||
| MiddleName: | PRASAD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GUPTA | ||||||||
| OtherFirstName: | NIRAJ | ||||||||
| OtherMiddleName: | PRASAD | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 31764 CASINO DR STE 300 | ||||||||
| Address2: | RIVERSIDE COUNTY MENTAL HEALTH | ||||||||
| City: | LAKE ELSINORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925304571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514714645 | ||||||||
| FaxNumber: | 9514714687 | ||||||||
| Practice Location | |||||||||
| Address1: | 31764 CASINO DR STE 300 | ||||||||
| Address2: | RIVERSIDE COUNTY MENTAL HEALTH | ||||||||
| City: | LAKE ELSINORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925304571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514714645 | ||||||||
| FaxNumber: | 9514714687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 11/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A92943 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.