Healthcare Provider Details

I. General information

NPI: 1790176782
Provider Name (Legal Business Name): RAMESH SHARMA MD RDMS RDCS RVT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16352 KEELER DR
GRANADA HILLS CA
91344-3035
US

IV. Provider business mailing address

16352 KEELER DR
GRANADA HILLS CA
91344-3035
US

V. Phone/Fax

Practice location:
  • Phone: 818-468-9683
  • Fax: 818-360-7494
Mailing address:
  • Phone: 818-468-9683
  • Fax: 818-360-7494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471V0106X
TaxonomyVascular-Interventional Technology Radiologic Technologist
License Number25254
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA30107
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code246XC2901X
TaxonomyCardiovascular Invasive Specialist/Technologist
License Number25254
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2471C1101X
TaxonomyCardiovascular-Interventional Technology Radiologic Technologist
License Number25254
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number112482
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number112482
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: