Healthcare Provider Details

I. General information

NPI: 1144922410
Provider Name (Legal Business Name): PRASTUTI SHRESTHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1162 MONTGOMERY DR STE 200
SANTA ROSA CA
95405-4802
US

IV. Provider business mailing address

1162 MONTGOMERY DR STE 200
SANTA ROSA CA
95405-4802
US

V. Phone/Fax

Practice location:
  • Phone: 707-890-4100
  • Fax: 707-473-2234
Mailing address:
  • Phone: 707-890-4100
  • Fax: 707-473-2234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA209156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: