Healthcare Provider Details

I. General information

NPI: 1518721810
Provider Name (Legal Business Name): SHARON CHARLES RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29377 RANCHO CALIFORNIA RD STE 103
TEMECULA CA
92591-5206
US

IV. Provider business mailing address

1035 LA TERRAZA CIR UNIT 205
CORONA CA
92879-7800
US

V. Phone/Fax

Practice location:
  • Phone: 951-387-5201
  • Fax: 866-502-2851
Mailing address:
  • Phone: 951-387-5201
  • Fax: 866-502-2851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86371326
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: