1740401264 NPI number — MRS. CHRISTY VERAJEAN SHARP CADC-CAS C052850518

Table of content: MRS. CHRISTY VERAJEAN SHARP CADC-CAS C052850518 (NPI 1740401264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740401264 NPI number — MRS. CHRISTY VERAJEAN SHARP CADC-CAS C052850518

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHARP
Provider First Name:
CHRISTY
Provider Middle Name:
VERAJEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CADC-CAS C052850518
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REED
Provider Other First Name:
CHRISTY
Provider Other Middle Name:
VERAJEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
F.A.C.T
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740401264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1393 BAILEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANFORD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93230-5922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-582-4481
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
539 N VAN NESS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93728-3419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-266-9581
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  F.A.C.T. #298 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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