Provider Demographics
NPI:1326481417
Name:SHARP HEALTHCARE
Entity Type:Organization
Organization Name:SHARP HEALTHCARE
Other - Org Name:SHARP REES-STEALY CLINICS LABORATORY FIR STREET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HROUNTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-262-6003
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:858-499-3020
Practice Address - Street 1:300 FIR ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2327
Practice Address - Country:US
Practice Address - Phone:619-446-1543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHARP HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-09
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D2056068291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00343750OtherCLF
CA05D2056068OtherCLIA