Provider Demographics
NPI:1740346584
Name:MINTZ, SHARON PHYLLIS (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:PHYLLIS
Last Name:MINTZ
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 1:22144 CLARENDON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6324
Mailing Address - Country:US
Mailing Address - Phone:818-999-1144
Mailing Address - Fax:818-226-5980
Practice Address - Street 1:22144 CLARENDON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6324
Practice Address - Country:US
Practice Address - Phone:818-999-1144
Practice Address - Fax:818-226-5980
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG459862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92615Medicare UPIN
CAG45986Medicare ID - Type UnspecifiedLICENSE