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General NPI Number Information
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NPI Number | 1386058030
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Entity Type | Organization
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Legal Business Name | SHARON PEACH CORPORATION
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 345 S HALCYON RD
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-3817
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Country | US
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Telephone | 805-928-1731
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Fax | 805-349-8160
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Provider Business Mailing Address
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Address Line | PO BOX 6406
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City | SANTA MARIA
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State | CA
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Zip | 93456-6406
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Country | US
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Telephone | 805-928-1731
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Fax | 805-349-8160
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHARON PEACH
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Credential | M.D.
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Telephone | 805-928-1731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C53730
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License Number State | CA
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