Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | A91593 | CA |
NPI | 1174609358 |
---|---|
Provider Name | Sanjay Sharma |
First Address | Pasadena, CA 91185-1190 |
Second Address | Fullerton, CA 92835-3801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A91593 | LICENSE (01) | CA |