Provider Demographics
NPI:1225548936
Name:BIVINS, SHARON LYNN
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LYNN
Last Name:BIVINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16743 ORVILLE WRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92518-2928
Mailing Address - Country:US
Mailing Address - Phone:951-567-5573
Mailing Address - Fax:
Practice Address - Street 1:16743 ORVILLE WRIGHT DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92518-2928
Practice Address - Country:US
Practice Address - Phone:951-567-5573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-07
Last Update Date:2017-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44493208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics