Healthcare Provider Details

I. General information

NPI: 1639366784
Provider Name (Legal Business Name): TODD GUTHRIE, M.D., PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 LASSEN LN
MOUNT SHASTA CA
96067-9003
US

IV. Provider business mailing address

635 LASSEN LN
MOUNT SHASTA CA
96067-9003
US

V. Phone/Fax

Practice location:
  • Phone: 530-926-5211
  • Fax: 530-926-5740
Mailing address:
  • Phone: 530-926-5211
  • Fax: 530-926-5740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG60880
License Number StateCA

VIII. Authorized Official

Name: DR. TODD B GUTHRIE
Title or Position: OWNER
Credential: M.D.
Phone: 530-926-5211