Healthcare Provider Details

I. General information

NPI: 1245055144
Provider Name (Legal Business Name): SHARNETT SIMONE BUSH BHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHARNETT SIMONE BUSH BHS

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10281 KIDD ST
RIVERSIDE CA
92503-3469
US

IV. Provider business mailing address

10281 KIDD ST
RIVERSIDE CA
92503-3469
US

V. Phone/Fax

Practice location:
  • Phone: 951-715-5050
  • Fax:
Mailing address:
  • Phone: 951-715-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: