Provider Demographics
NPI:1982909446
Name:SHARP IMAGING MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:SHARP IMAGING MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:NOLAN
Authorized Official - Last Name:BROURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-657-2202
Mailing Address - Street 1:PO BOX 51081
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-5381
Mailing Address - Country:US
Mailing Address - Phone:818-815-3910
Mailing Address - Fax:818-933-7550
Practice Address - Street 1:14600 SHERMAN WAY
Practice Address - Street 2:SUITE 100A
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2283
Practice Address - Country:US
Practice Address - Phone:818-815-3910
Practice Address - Fax:818-933-7550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center