Healthcare Provider Details

I. General information

NPI: 1710161559
Provider Name (Legal Business Name): SHARON ANN GOLUB RN MN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

IV. Provider business mailing address

22034 GRANT AVE
TORRANCE CA
90503-6925
US

V. Phone/Fax

Practice location:
  • Phone: 213-351-5369
  • Fax:
Mailing address:
  • Phone: 310-316-2159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number169543
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number169543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: