Provider Demographics
NPI:1184791550
Name:ATTISHA, SHEREEN BINNO (MD)
Entity type:Individual
Prefix:
First Name:SHEREEN
Middle Name:BINNO
Last Name:ATTISHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHEREEN
Other - Middle Name:
Other - Last Name:BINNO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8010 FROST ST.
Mailing Address - Street 2:#301
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:858-292-7200
Mailing Address - Fax:858-505-0304
Practice Address - Street 1:8010 FROST ST.
Practice Address - Street 2:#301
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-292-7200
Practice Address - Fax:858-505-0304
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067973207V00000X
CAC53444207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104731738Medicaid
MI104731738Medicaid
MIH30332Medicare UPIN