Healthcare Provider Details

I. General information

NPI: 1356634489
Provider Name (Legal Business Name): RAHUL SHARMA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24411 HEALTH CENTER DR STE 350
LAGUNA HILLS CA
92653-3687
US

IV. Provider business mailing address

24411 HEALTH CENTER DR STE 350
LAGUNA HILLS CA
92653-3687
US

V. Phone/Fax

Practice location:
  • Phone: 949-457-7900
  • Fax: 949-588-8719
Mailing address:
  • Phone: 949-457-7900
  • Fax: 949-588-8719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101019285
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number20A14623
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: