Provider Demographics
NPI:1275096521
Name:SHARP HEALTHCARE
Entity Type:Organization
Organization Name:SHARP HEALTHCARE
Other - Org Name:SHARP REES STEALY CLINICAL LABORATORY - GENESEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO SHARP HEALTHCARE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-499-4004
Mailing Address - Street 1:8695 SPECTRUM CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1489
Mailing Address - Country:US
Mailing Address - Phone:858-499-3025
Mailing Address - Fax:
Practice Address - Street 1:2020 GENESEE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4219
Practice Address - Country:US
Practice Address - Phone:858-616-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHARP HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-12
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00354098OtherCLF
CA05D2167404OtherCLIA