Provider Demographics
NPI:1649386707
Name:GUPTA, PRAVEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAVEEN
Middle Name:
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 1:9435 VENICE BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2623
Mailing Address - Country:US
Mailing Address - Phone:310-559-0575
Mailing Address - Fax:310-839-5473
Practice Address - Street 1:9435 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2623
Practice Address - Country:US
Practice Address - Phone:310-559-0575
Practice Address - Fax:310-839-5473
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25680207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology