Healthcare Provider Details

I. General information

NPI: 1730521568
Provider Name (Legal Business Name): SHARPCARE MEDICAL GROUP, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 PROSPECT PLACE SUITE 340-B
CORONADO CA
92118
US

IV. Provider business mailing address

8695 SPECTRUM CENTER BLVD. ATTN: NETWORK MANAGEMENT - 4TH FLOOR
SAN DIEGO CA
92123
US

V. Phone/Fax

Practice location:
  • Phone: 619-522-4000
  • Fax: 619-435-0150
Mailing address:
  • Phone: 858-499-4510
  • Fax: 858-636-2243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH ROTH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-541-0181