Provider Demographics
NPI:1982694576
Name:SHARIF, SUBHI G (MD)
Entity Type:Individual
Prefix:
First Name:SUBHI
Middle Name:G
Last Name:SHARIF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E LATHAM AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4370
Mailing Address - Country:US
Mailing Address - Phone:951-658-7455
Mailing Address - Fax:951-658-9795
Practice Address - Street 1:750 E LATHAM AVE
Practice Address - Street 2:STE 2
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4370
Practice Address - Country:US
Practice Address - Phone:951-658-7455
Practice Address - Fax:951-658-9795
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC42984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C429840Medicaid
D75448Medicare UPIN
CA00C429840Medicaid