Provider Demographics
NPI:1649545070
Name:SHAREN KNUDSEN JEFFRIES MD PC
Entity type:Organization
Organization Name:SHAREN KNUDSEN JEFFRIES MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHAREN
Authorized Official - Middle Name:K
Authorized Official - Last Name:JEFFRIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-793-2500
Mailing Address - Street 1:100 EDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7210
Mailing Address - Country:US
Mailing Address - Phone:909-793-2500
Mailing Address - Fax:909-793-2502
Practice Address - Street 1:400 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 500
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7601
Practice Address - Country:US
Practice Address - Phone:909-793-2500
Practice Address - Fax:909-793-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50970261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty