1467621995 NPI number — DR. SHARON SHAMBRAY MCGARRITY D.O.

Table of content: DR. SHARON SHAMBRAY MCGARRITY D.O. (NPI 1467621995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467621995 NPI number — DR. SHARON SHAMBRAY MCGARRITY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGARRITY
Provider First Name:
SHARON
Provider Middle Name:
SHAMBRAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467621995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3750 SANTA ROSALIA DR
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90008-3627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-294-1160
Provider Business Mailing Address Fax Number:
323-294-8191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3750 SANTA ROSALIA DR
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90008-3627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-294-1160
Provider Business Practice Location Address Fax Number:
323-294-8191
Provider Enumeration Date:
02/28/2008

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: 207QA0505X , with the licence number:  20A4473 , 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)

  • Identifier: 00AX44730 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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