Healthcare Provider Details

I. General information

NPI: 1447328547
Provider Name (Legal Business Name): CENTER FOR METABOLIC BONE DISEASE &
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONGRESS ST SUITE 512
PASADENA CA
91105-3045
US

IV. Provider business mailing address

10 CONGRESS ST SUITE 512
PASADENA CA
91105-3045
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-9013
  • Fax: 626-449-8716
Mailing address:
  • Phone: 626-449-9013
  • Fax: 626-449-8716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG21537
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberG21537
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG21537
License Number StateCA

VIII. Authorized Official

Name: MR. CHARLES F SHARP JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 626-449-9013