Healthcare Provider Details

I. General information

NPI: 1689457574
Provider Name (Legal Business Name): SBMD MEDICAL CORPORATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 S MOTIF ST
ANAHEIM CA
92805-4749
US

IV. Provider business mailing address

2034 E LINCOLN AVE STE 408
ANAHEIM CA
92806-4101
US

V. Phone/Fax

Practice location:
  • Phone: 714-400-9992
  • Fax:
Mailing address:
  • Phone: 714-400-9992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARMA L BISHOP
Title or Position: OWNER
Credential: MD
Phone: 347-553-9247