MEDICARE: SHARP CORONADO HOSPITAL AND HEALTHCARE CENTER

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
1	3336C0003X	Community/Retail Pharmacy	PHY36561	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2036040	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740227727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARP CORONADO HOSPITAL AND HEALTHCARE CENTER

Provider Business Mailing Address
First Line	:	8695 SPECTRUM CENTER BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123
Country	:	US
Telephone Number	:	858-499-3025
Fax Number	:	858-499-4738

Provider Business Practice Location Address
First Line	:	230 PROSPECT PL
Second Line	:	STE 110
City	:	CORONADO
State	:	CA
Zip	:	92118-1978
Country	:	US
Telephone Number	:	619-522-3996
Fax Number	:	619-437-0652

Authorized Official
Title or Position	:	CEO
Name	:	SUSAN STONE
Credential	:
Telephone Number	:	619-522-3700

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	08/08/2017

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Directions to “SHARP CORONADO HOSPITAL AND HEALTHCARE CENTER ” Practice Location

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