1689689176 NPI number — LORRA MARIE SHARP MD

Table of content: LORRA MARIE SHARP MD (NPI 1689689176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689689176 NPI number — LORRA MARIE SHARP MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHARP
Provider First Name:
LORRA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1689689176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15611 POMERADO RD STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POWAY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92064-2437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-675-3100
Provider Business Mailing Address Fax Number:
858-613-2930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1955 CITRACADO PKWY STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92029-4112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-743-4789
Provider Business Practice Location Address Fax Number:
858-673-5187
Provider Enumeration Date:
07/31/2006

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: 207XX0801X , with the licence number:  A117353 , 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: A117353 . This is a "CA LISENCE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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