Healthcare Provider Details

I. General information

NPI: 1215207469
Provider Name (Legal Business Name): ANNU G. SHARMA, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15785 LAGUNA CANYON RD SUITE 215
IRVINE CA
92618-3165
US

IV. Provider business mailing address

15785 LAGUNA CANYON RD SUITE 215
IRVINE CA
92618-3165
US

V. Phone/Fax

Practice location:
  • Phone: 949-753-0901
  • Fax: 949-753-7443
Mailing address:
  • Phone: 949-753-0901
  • Fax: 949-753-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA43676
License Number StateCA

VIII. Authorized Official

Name: DR. ANNU G. SHARMA
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 949-753-0901