Healthcare Provider Details

I. General information

NPI: 1790799849
Provider Name (Legal Business Name): SUSAN GUIDICI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S ELISEO DR STE 3
GREENBRAE CA
94904-2017
US

IV. Provider business mailing address

642 JADE ST
PETALUMA CA
94952-5315
US

V. Phone/Fax

Practice location:
  • Phone: 415-798-9711
  • Fax:
Mailing address:
  • Phone: 707-364-4944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCACRNA2501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: