Basic Information
Provider Information | |||||||||
NPI: | 1780998021 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SHARMA | ||||||||
FirstName: | ABHILASHA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1910 CUSTOMER CARE WAY | ||||||||
Address2: |   | ||||||||
City: | ATWATER | ||||||||
State: | CA | ||||||||
PostalCode: | 953015167 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2093846488 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 847 W CHILDS AVE | ||||||||
Address2: |   | ||||||||
City: | MERCED | ||||||||
State: | CA | ||||||||
PostalCode: | 953416862 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2093837441 | ||||||||
FaxNumber: | 2093837813 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/28/2010 | ||||||||
LastUpdateDate: | 12/05/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | RL11595 | ND | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | A123145 | CA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | A123145 | 01 | CA | MEDICAL LICENSE | OTHER |