Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC17713 | CA |
N | 111NI0013X | Independent Medical Examiner | DC17713 | CA |
NPI | 1790907525 |
---|---|
Provider Name | Dr. Rae Hunt Sharp |
First Address | San Bernardino, CA 92405-2615 |
Second Address | San Bernardino, CA 92405-2615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T0643 | (02) | CA |