Healthcare Provider Details

I. General information

NPI: 1740227727
Provider Name (Legal Business Name): SHARP CORONADO HOSPITAL AND HEALTHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 PROSPECT PL STE 110
CORONADO CA
92118-1978
US

IV. Provider business mailing address

8695 SPECTRUM CENTER BLVD
SAN DIEGO CA
92123
US

V. Phone/Fax

Practice location:
  • Phone: 619-522-3996
  • Fax: 619-437-0652
Mailing address:
  • Phone: 858-499-3025
  • Fax: 858-499-4738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY36561
License Number StateCA

VIII. Authorized Official

Name: SUSAN STONE
Title or Position: CEO
Credential:
Phone: 619-522-3700