Basic Information
| Provider Information | |||||||||
| NPI: | 1366864258 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHARP REES-STEALY MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 939087 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921939087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582626344 | ||||||||
| FaxNumber: | 8586362032 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 VIA DE LA VALLE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | DEL MAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194461530 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2014 | ||||||||
| LastUpdateDate: | 07/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | BIER | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8582626666 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SHARP REES-STEALY MEDICAL GROUP, INC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.