Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | SL1368 | NV |
NPI | 1023509502 |
---|---|
Provider Name | Dr. Shivali Gupta |
First Address | Las Vegas, NV 89106-4194 |
Second Address | Las Vegas, NV 89106-4194 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2018 |
Last Update Date | 21/05/2018 |