Healthcare Provider Details

I. General information

NPI: 1245394360
Provider Name (Legal Business Name): SMITA RANI GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 6TH ST STE 203
SANTA MONICA CA
90401-1637
US

IV. Provider business mailing address

1217 WILSHIRE BLVD # 3367
SANTA MONICA CA
90403-5466
US

V. Phone/Fax

Practice location:
  • Phone: 424-259-2889
  • Fax: 424-229-9943
Mailing address:
  • Phone: 424-259-2889
  • Fax: 424-229-9943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMT181623
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA101037
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA101037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: