Healthcare Provider Details

I. General information

NPI: 1114901352
Provider Name (Legal Business Name): SHARP MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 HEALTH CENTER DR
SAN DIEGO CA
92123-2762
US

IV. Provider business mailing address

8695 SPECTRUM CENTER BLVD
SAN DIEGO CA
92123-1489
US

V. Phone/Fax

Practice location:
  • Phone: 858-939-3400
  • Fax: 858-499-4738
Mailing address:
  • Phone: 858-499-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number080000039
License Number StateCA

VIII. Authorized Official

Name: TIM SMITH
Title or Position: CEO
Credential:
Phone: 858-939-4082