Healthcare Provider Details

I. General information

NPI: 1144687732
Provider Name (Legal Business Name): SHARON JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42322 CIRCULO CAVINARA
MURRIETA CA
92562-6150
US

IV. Provider business mailing address

42322 CIRCULO CAVINARA
MURRIETA CA
92562-6150
US

V. Phone/Fax

Practice location:
  • Phone: 909-731-1916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberAT2312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: