Healthcare Provider Details

I. General information

NPI: 1629632906
Provider Name (Legal Business Name): SOURABH SHARMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8762
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8762
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-8173
  • Fax:
Mailing address:
  • Phone: 559-353-8173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberU5813
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberA208978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: