Healthcare Provider Details

I. General information

NPI: 1295187003
Provider Name (Legal Business Name): SHARON L. BIVINS, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16743 ORVILLE WRIGHT DR
RIVERSIDE CA
92518-2928
US

IV. Provider business mailing address

16743 ORVILLE WRIGHT DR
RIVERSIDE CA
92518-2928
US

V. Phone/Fax

Practice location:
  • Phone: 951-567-5573
  • Fax:
Mailing address:
  • Phone: 951-567-5573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG44493
License Number StateCA

VIII. Authorized Official

Name: DR. SHARON L BIVINS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 951-567-5573