Healthcare Provider Details

I. General information

NPI: 1205188471
Provider Name (Legal Business Name): PIRASTEH GUITY SHAFE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PIRA S GUITY

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 GRESHAM DR
EL DORADO HILLS CA
95762
US

IV. Provider business mailing address

P.O BOX 4948
EL DORADO HILLS CA
95762
US

V. Phone/Fax

Practice location:
  • Phone: 916-939-4248
  • Fax:
Mailing address:
  • Phone: 916-719-9227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAFE41451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: