MEDICARE: MR. SANJAY SHARMA

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	164X00000X	Licensed Vocational Nurse	743449	CA

General Provider Information

NPI Number	:	1972331957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SANJAY SHARMA

Provider Business Mailing Address
First Line	:	22704 VENTURA BLVD
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1333
Country	:	US
Telephone Number	:	714-932-5774
Fax Number	:

Provider Business Practice Location Address
First Line	:	22704 VENTURA BLVD
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1333
Country	:	US
Telephone Number	:	714-932-5774
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	07/23/2024

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