Healthcare Provider Details

I. General information

NPI: 1043381015
Provider Name (Legal Business Name): RANI N. GOWRINATHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4733 W SUNSET BLVD
LOS ANGELES CA
90027-6021
US

IV. Provider business mailing address

4733 W SUNSET BLVD
LOS ANGELES CA
90027-6021
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-4011
  • Fax:
Mailing address:
  • Phone: 323-783-4011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA39204
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA39204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: