Provider Demographics
NPI:1316085632
Name:SHARMA, MINU (MD)
Entity type:Individual
Prefix:DR
First Name:MINU
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28743 VALLEY CENTER RD STE B
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-6530
Mailing Address - Country:US
Mailing Address - Phone:760-749-0824
Mailing Address - Fax:760-749-2189
Practice Address - Street 1:28743 VALLEY CENTER RD STE B
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-6530
Practice Address - Country:US
Practice Address - Phone:760-749-0824
Practice Address - Fax:760-749-2189
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106195207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50025790OtherPASSPORT
CAW14158OtherSITE PTAN
CAA106195OtherMEDICAL LICENSE
CAA106195OtherMEDICAL LICENSE
KY3737636000OtherPASSPORT ADVANTAGE
KY00162084Medicare PIN
CAET021YMedicare UPIN