Healthcare Provider Details

I. General information

NPI: 1275924631
Provider Name (Legal Business Name): SHARON R OHARA MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 W CAPITOL DR UNIT 117
SAN PEDRO CA
90732-5015
US

IV. Provider business mailing address

1150 W CAPITOL DR UNIT 117
SAN PEDRO CA
90732-5015
US

V. Phone/Fax

Practice location:
  • Phone: 310-326-5534
  • Fax:
Mailing address:
  • Phone: 310-326-5534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: