Basic Information
| Provider Information | |||||||||
| NPI: | 1568762540 | ||||||||
| 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: | 8881 FLETCHER PKWY | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194461646 | ||||||||
| FaxNumber: | 8586362032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2010 | ||||||||
| LastUpdateDate: | 07/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | GREEN | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8582626666 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SHARP REES-STEALY MEDICAL GROUP, INC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.