Provider Demographics
NPI:1629194121
Name:GUISARD, MARSHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:
Last Name:GUISARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:
Other - Last Name:BLUTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2490
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94942-2490
Mailing Address - Country:US
Mailing Address - Phone:415-380-1840
Mailing Address - Fax:
Practice Address - Street 1:591 REDWOOD HWY
Practice Address - Street 2:SUITE 5285
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941
Practice Address - Country:US
Practice Address - Phone:415-380-1840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106091208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation