Provider Demographics
NPI:1598193609
Name:NAMITA SHARAN MFT
Entity Type:Organization
Organization Name:NAMITA SHARAN MFT
Other - Org Name:SAN PEDRO HEALING ARTS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RND, LAC
Authorized Official - Phone:310-547-2197
Mailing Address - Street 1:1366 W 7TH ST
Mailing Address - Street 2:SUITE 4-B
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3500
Mailing Address - Country:US
Mailing Address - Phone:310-547-2197
Mailing Address - Fax:310-547-9532
Practice Address - Street 1:1366 W 7TH ST
Practice Address - Street 2:SUITE 4-B
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3500
Practice Address - Country:US
Practice Address - Phone:310-547-2197
Practice Address - Fax:310-547-9532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC51281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC51281OtherSTATE LIC