Healthcare Provider Details

I. General information

NPI: 1831486240
Provider Name (Legal Business Name): SUAMHIRS MONTECRISTO PIRAINO-GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 E 17TH ST
SANTA ANA CA
92705-8506
US

IV. Provider business mailing address

1575 E 17TH ST
SANTA ANA CA
92705-8506
US

V. Phone/Fax

Practice location:
  • Phone: 714-619-0212
  • Fax:
Mailing address:
  • Phone: 714-619-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberB3453JP
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: