Provider Demographics
NPI:1063836120
Name:JOSEPH, SHARY
Entity type:Individual
Prefix:
First Name:SHARY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2056
Mailing Address - Country:US
Mailing Address - Phone:562-832-7792
Mailing Address - Fax:
Practice Address - Street 1:303 N EAST ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3341
Practice Address - Country:US
Practice Address - Phone:714-491-1771
Practice Address - Fax:714-491-1370
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000247363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care