Healthcare Provider Details

I. General information

NPI: 1982909446
Provider Name (Legal Business Name): SHARP IMAGING MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14600 SHERMAN WAY SUITE 100A
VAN NUYS CA
91405-2283
US

IV. Provider business mailing address

PO BOX 51081
LOS ANGELES CA
90051-5381
US

V. Phone/Fax

Practice location:
  • Phone: 818-815-3910
  • Fax: 818-933-7550
Mailing address:
  • Phone: 818-815-3910
  • Fax: 818-933-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVEN NOLAN BROURMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-657-2202