Provider Demographics
NPI:1376712141
Name:VENUGOPAL, GUHAPRIYA AMARESAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GUHAPRIYA
Middle Name:AMARESAN
Last Name:VENUGOPAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:19037 OWEN WAY
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7347
Mailing Address - Country:US
Mailing Address - Phone:562-809-6076
Mailing Address - Fax:562-809-6076
Practice Address - Street 1:3601 SW 160TH AVE
Practice Address - Street 2:SUITE #250
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6308
Practice Address - Country:US
Practice Address - Phone:305-866-9951
Practice Address - Fax:305-614-3352
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70289208100000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAX789ZMedicare PIN
CAAX789YMedicare PIN