Healthcare Provider Details

I. General information

NPI: 1588784334
Provider Name (Legal Business Name): PRAVIN T GOUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 W LINCOLN AVE
ANAHEIM CA
92801-6742
US

IV. Provider business mailing address

1808 W LINCOLN AVE
ANAHEIM CA
92801-6742
US

V. Phone/Fax

Practice location:
  • Phone: 833-988-9898
  • Fax: 714-678-1462
Mailing address:
  • Phone: 833-988-9898
  • Fax: 714-678-1462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA104184
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberA104184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: