Provider Demographics
NPI:1447334123
Name:GORWARA, ANITA MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:MICHELLE
Last Name:GORWARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:GORWARA-DOHAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2020 SANTA MONICA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2013
Mailing Address - Country:US
Mailing Address - Phone:310-582-7313
Mailing Address - Fax:310-315-6118
Practice Address - Street 1:901 WILSHIRE BLVD FL 3
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1854
Practice Address - Country:US
Practice Address - Phone:310-829-8903
Practice Address - Fax:424-212-5933
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14560BOtherGROUP PTAN
CAW14560AOtherGROUP PTAN
CAW14560OtherGROUP PTAN
CAW14560COtherGROUP PTAN
CAW14560DOtherGROUP PTAN
CAW14560OtherGROUP PTAN
CAWA74221CMedicare PIN
CAW14560BOtherGROUP PTAN
CAW14560AOtherGROUP PTAN
CAWA74221GMedicare PIN
CAWA74221EMedicare PIN
CAG64066Medicare UPIN