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General NPI Number Information
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NPI Number | 1578604237
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Entity Type | Individual
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Provider Name | SHARON MARLENE WOLLASTON M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1411 N HOLLYWOOD WAY
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City | BURBANK
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State | CA
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Zip | 91505-1826
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Country | US
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Telephone | 818-841-9990
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Fax | 818-972-9067
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Provider Business Mailing Address
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Address Line | 4517 SIMPSON AVE
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City | STUDIO CITY
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State | CA
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Zip | 91607-4134
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Country | US
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Telephone | 818-985-7334
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Fax | 818-972-9067
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A064194
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License Number State | CA
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