Provider Demographics
NPI:1508849001
Name:GUIRGUIS, LISA M (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:GUIRGUIS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:855-771-0335
Mailing Address - Fax:
Practice Address - Street 1:2800 L ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5616
Practice Address - Country:US
Practice Address - Phone:916-733-9660
Practice Address - Fax:916-733-9662
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2015-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA562532086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A562530Medicare ID - Type UnspecifiedPPIN
CAH87293Medicare UPIN