Provider Demographics
NPI:1245394360
Name:GUPTA, SMITA RANI (MD)
Entity Type:Individual
Prefix:
First Name:SMITA
Middle Name:RANI
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 1:1002 4TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-3847
Mailing Address - Country:US
Mailing Address - Phone:424-259-2889
Mailing Address - Fax:424-229-9943
Practice Address - Street 1:1460 7TH ST STE 301
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2632
Practice Address - Country:US
Practice Address - Phone:424-259-2889
Practice Address - Fax:424-229-9943
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101037207R00000X, 207RR0500X
PAMT181623207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADM184AMedicare PIN
CAWA101037BMedicare PIN
CAWA101037AMedicare PIN