Healthcare Provider Details

I. General information

NPI: 1295210177
Provider Name (Legal Business Name): SARAH SHARPE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 CAMINO DE LA REINA
SAN DIEGO CA
92108-3102
US

IV. Provider business mailing address

591 CAMINO DE LA REINA STE 210
SAN DIEGO CA
92108-3104
US

V. Phone/Fax

Practice location:
  • Phone: 760-487-8295
  • Fax:
Mailing address:
  • Phone: 619-268-1098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: