Healthcare Provider Details

I. General information

NPI: 1336280940
Provider Name (Legal Business Name): SHARP COMMUNITY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8695 SPECTRUM CENTER BLVD
SAN DIEGO CA
92123-1489
US

IV. Provider business mailing address

8695 SPECTRUM CENTER BLVD
SAN DIEGO CA
92123-1489
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-4525
  • Fax:
Mailing address:
  • Phone: 858-499-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER MCGLONE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 858-499-4575