Provider Demographics
NPI:1235477910
Name:SHARIF, ELHAM
Entity Type:Individual
Prefix:MRS
First Name:ELHAM
Middle Name:
Last Name:SHARIF
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 1:22661 LAMBERT ST STE 202
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1612
Mailing Address - Country:US
Mailing Address - Phone:949-455-0404
Mailing Address - Fax:949-455-0641
Practice Address - Street 1:22661 LAMBERT ST STE 202
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1612
Practice Address - Country:US
Practice Address - Phone:949-455-0404
Practice Address - Fax:949-455-0641
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
CACPED2182224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment