=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740227727
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARP CORONADO HOSPITAL AND HEALTHCARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2006
-----------------------------------------------------
Last Update Date | 08/08/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 PROSPECT PL STE 110
-----------------------------------------------------
City | CORONADO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92118-1978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-522-3996
-----------------------------------------------------
Fax | 619-437-0652
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8695 SPECTRUM CENTER BLVD
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-499-3025
-----------------------------------------------------
Fax | 858-499-4738
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SUSAN STONE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 619-522-3700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY36561
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------