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NPI Code Detail

MEDICARE: DR. SHARON MARLENE WOLLASTON M.D.

MEDICARE: DR. SHARON MARLENE WOLLASTON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianA064194CA

General Provider Information

NPI Number : 1578604237
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHARON MARLENE WOLLASTON M.D.
Provider Business Mailing Address
First Line : 4517 SIMPSON AVE
Second Line :
City : STUDIO CITY
State : CA
Zip : 91607-4134
Country : US
Telephone Number : 818-985-7334
Fax Number : 818-972-9067
Provider Business Practice Location Address
First Line : 1411 N HOLLYWOOD WAY
Second Line :
City : BURBANK
State : CA
Zip : 91505-1826
Country : US
Telephone Number : 818-841-9990
Fax Number : 818-972-9067
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2007
Last Update Date : 07/08/2007

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