Basic Information
| Provider Information | |||||||||
| NPI: | 1457387250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DREEBEN | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9339 GENESEE AVE | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921212119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586257979 | ||||||||
| FaxNumber: | 8586252020 | ||||||||
| Practice Location | |||||||||
| Address1: | 9339 GENESEE AVE | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921212119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586257979 | ||||||||
| FaxNumber: | 8586252020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 07/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0004X | G67534 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00G675340 | 05 | CA | MEDICAID |