Healthcare Provider Details

I. General information

NPI: 1730549189
Provider Name (Legal Business Name): SHAREN CARIZO WILSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAREN CARIZO KEMP-DUKES DO

II. Dates (important events)

Enumeration Date: 02/28/2016
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18TH MEDICAL GROUP UNIT 5142
APO AP
96368
US

IV. Provider business mailing address

18TH MDG UNIT 5142
APO AP
96368
US

V. Phone/Fax

Practice location:
  • Phone: 98-971-7488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: