Provider Demographics
NPI:1083647424
Name:THE S.H.A.R.P. TREATMENT OF SOUTH BAY, INC
Entity Type:Organization
Organization Name:THE S.H.A.R.P. TREATMENT OF SOUTH BAY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-626-8037
Mailing Address - Street 1:2557A PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-7035
Mailing Address - Country:US
Mailing Address - Phone:310-626-8037
Mailing Address - Fax:310-626-8038
Practice Address - Street 1:2557A PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-7035
Practice Address - Country:US
Practice Address - Phone:310-626-8037
Practice Address - Fax:310-626-8038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27490111N00000X
CADC29265111N00000X
CAC52232207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6318220002Medicare NSC