Provider Demographics
NPI:1073876900
Name:SHARI M KREVITZ MD, INC
Entity Type:Organization
Organization Name:SHARI M KREVITZ MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:M
Authorized Official - Last Name:KREVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-345-0131
Mailing Address - Street 1:10777 CANYON GRV
Mailing Address - Street 2:#48
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4926
Mailing Address - Country:US
Mailing Address - Phone:858-345-0131
Mailing Address - Fax:858-345-0131
Practice Address - Street 1:10777 CANYON GRV
Practice Address - Street 2:#48
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-4926
Practice Address - Country:US
Practice Address - Phone:858-345-0131
Practice Address - Fax:858-345-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103546207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty