Provider Demographics
NPI:1407096589
Name:SHARP REES-STEALY MEDICAL CENTER
Entity Type:Organization
Organization Name:SHARP REES-STEALY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:AQUINO
Authorized Official - Last Name:CLAUDIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-397-3077
Mailing Address - Street 1:1423 WOODEN VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2952
Mailing Address - Country:US
Mailing Address - Phone:619-746-1067
Mailing Address - Fax:
Practice Address - Street 1:1400 E PALOMAR ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1800
Practice Address - Country:US
Practice Address - Phone:619-397-3077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHARP REES-STEALY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-02
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26793225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty