Individual
DR. SHIVANI GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
13652 CANTARA ST, BUILDING 2, PANORAMA CITY, CA 91402-5423
(818) 375-1750
Mailing address
13652 CANTARA ST, BUILDING 2, PANORAMA CITY, CA 91402-5423
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
137240
CA
207W00000X
Ophthalmology Physician
4301097505
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
137240
MEDICAL LICENSE
CA
Enumeration date
06/18/2007
Last updated
09/03/2015
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