Provider Demographics
NPI:1932296357
Name:GURA, VICTOR (MD)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:GURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 N LA CIENEGA BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2241
Mailing Address - Country:US
Mailing Address - Phone:310-550-6240
Mailing Address - Fax:310-289-0142
Practice Address - Street 1:99 N LA CIENEGA BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2222
Practice Address - Country:US
Practice Address - Phone:310-550-6240
Practice Address - Fax:310-289-9959
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34872207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A348720Medicaid
CA00A348720Medicaid
A27612Medicare UPIN
W8076Medicare ID - Type UnspecifiedGROUP
WA34872BMedicare ID - Type Unspecified