Healthcare Provider Details

I. General information

NPI: 1891213666
Provider Name (Legal Business Name): SHARIF J HAYWOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 PARKMOOR AVE
SAN JOSE CA
95126-3403
US

IV. Provider business mailing address

1401 PARKMOOR AVE
SAN JOSE CA
95126-3403
US

V. Phone/Fax

Practice location:
  • Phone: 408-971-9822
  • Fax: 408-510-3484
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: