Healthcare Provider Details

I. General information

NPI: 1366401580
Provider Name (Legal Business Name): SUSAN M SHARP DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12555 GARDEN GROVE BLVD STE 304
GARDEN GROVE CA
92843-1903
US

IV. Provider business mailing address

12555 GARDEN GROVE BLVD STE 304
GARDEN GROVE CA
92843-1903
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-5988
  • Fax: 714-542-5988
Mailing address:
  • Phone: 714-542-5988
  • Fax: 714-798-9756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: