Healthcare Provider Details

I. General information

NPI: 1366734071
Provider Name (Legal Business Name): SAMEER SHARMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 K ST STE 401
SACRAMENTO CA
95816-5119
US

IV. Provider business mailing address

2801 K ST STE 410
SACRAMENTO CA
95816-5119
US

V. Phone/Fax

Practice location:
  • Phone: 916-389-7100
  • Fax:
Mailing address:
  • Phone: 169-389-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberQ2947
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA119733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: