Provider Demographics
NPI:1003851015
Name:WASHINGTON, SHARON DENISE (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:DENISE
Last Name:WASHINGTON
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 1:632 W 11TH ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3856
Mailing Address - Country:US
Mailing Address - Phone:209-836-3384
Mailing Address - Fax:209-835-3871
Practice Address - Street 1:632 W 11TH ST
Practice Address - Street 2:SUITE 211
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3856
Practice Address - Country:US
Practice Address - Phone:209-836-3384
Practice Address - Fax:209-835-3871
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70516207V00000X
CAAJ366938208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG705160Medicaid
CA00G705161Medicare PIN
CAOOG705160Medicaid