MEDICARE: PRAVEEN GUPTA A MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	A25680	CA

General Provider Information

NPI Number	:	1891295408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRAVEEN GUPTA A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	10542 VENICE BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-3308
Country	:	US
Telephone Number	:	310-559-0575
Fax Number	:	310-839-5473

Provider Business Practice Location Address
First Line	:	10542 VENICE BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-3308
Country	:	US
Telephone Number	:	310-559-0575
Fax Number	:	310-839-5473

Authorized Official
Title or Position	:	MD
Name	:	DR. PRAVEEN GUPTA
Credential	:	MD
Telephone Number	:	310-430-2100

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	01/27/2026

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