Healthcare Provider Details

I. General information

NPI: 1235477910
Provider Name (Legal Business Name): ELHAM SHARIF MSPO, CPO, CPED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 BRISTOL ST STE 110
COSTA MESA CA
92626-5985
US

IV. Provider business mailing address

56 SEQUOIA TREE LN
IRVINE CA
92612-2227
US

V. Phone/Fax

Practice location:
  • Phone: 949-455-0404
  • Fax: 949-266-8182
Mailing address:
  • Phone: 949-412-2633
  • Fax: 949-266-8182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO05605
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberCPED4123
License Number State
# 4
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO05605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: