Healthcare Provider Details

I. General information

NPI: 1700591443
Provider Name (Legal Business Name): ANIRUDH GUPTA MD PHD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 N BRENT ST
VENTURA CA
93003-2809
US

IV. Provider business mailing address

245 W BROADWAY APT 743
LONG BEACH CA
90802-5081
US

V. Phone/Fax

Practice location:
  • Phone: 805-948-5011
  • Fax:
Mailing address:
  • Phone: 214-773-5947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANIRUDH GUPTA
Title or Position: PRESIDENT
Credential: MD PHD
Phone: 214-773-5947