Healthcare Provider Details

I. General information

NPI: 1265461735
Provider Name (Legal Business Name): SHARON DAVIDA GARNER MPAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD 111-F
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

11301 WILSHIRE BLVD 111-F
LOS ANGELES CA
90073-1003
US

V. Phone/Fax

Practice location:
  • Phone: 310-268-3101
  • Fax: 310-268-4928
Mailing address:
  • Phone: 310-268-3101
  • Fax: 310-268-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1011882
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: