Healthcare Provider Details

I. General information

NPI: 1205129731
Provider Name (Legal Business Name): GAURAV BANKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 LOMITA BLVD STE 100
TORRANCE CA
90505-5100
US

IV. Provider business mailing address

2841 LOMITA BLVD STE 100
TORRANCE CA
90505-5100
US

V. Phone/Fax

Practice location:
  • Phone: 310-257-0508
  • Fax: 310-325-8109
Mailing address:
  • Phone: 310-257-0508
  • Fax: 310-325-8109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA123190
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA123190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: