Provider Demographics
NPI:1336339449
Name:GROSPE, SHARON REYES
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:REYES
Last Name:GROSPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 E 220TH ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2439
Mailing Address - Country:US
Mailing Address - Phone:310-402-4989
Mailing Address - Fax:
Practice Address - Street 1:1554 E 220TH ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2439
Practice Address - Country:US
Practice Address - Phone:310-402-4989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 226751164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse