Individual
AVANI R GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1950 E LOS ANGELES AVE, SIMI VALLEY, CA 93065-3503
(805) 306-1440
(805) 306-1758
Mailing address
1950 E LOS ANGELES AVE, SIMI VALLEY, CA 93065-3503
(805) 306-1440
(805) 306-1758
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A11616
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20A11616
OSTEOPATHIC MEDICAL BOARD LICENSE
CA
Enumeration date
06/05/2008
Last updated
02/24/2014
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