Provider Demographics
NPI:1407868557
Name:BLOSK, SHARON A (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:BLOSK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 ALHAMBRA BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5238
Mailing Address - Country:US
Mailing Address - Phone:916-451-4400
Mailing Address - Fax:916-731-7955
Practice Address - Street 1:1201 ALHAMBRA BLVD
Practice Address - Street 2:STE 300
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5238
Practice Address - Country:US
Practice Address - Phone:916-451-4400
Practice Address - Fax:916-731-7955
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A51390Medicaid
F44987Medicare UPIN
00A501390Medicare ID - Type Unspecified