Healthcare Provider Details

I. General information

NPI: 1124598974
Provider Name (Legal Business Name): SHARON DENISE WANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON WARREN, PILSON, QUIROZ, BARBAGELLO

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E DEVONSHIRE AVE
HEMET CA
92543-3083
US

IV. Provider business mailing address

418 LANA WAY
BEAUMONT CA
92223-7019
US

V. Phone/Fax

Practice location:
  • Phone: 951-652-2811
  • Fax:
Mailing address:
  • Phone: 951-795-8392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: