Basic Information
Provider Information | |||||||||
NPI: | 1134377633 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ADHIKARY SHARMA | ||||||||
FirstName: | SARINA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 332 S JUNIPER ST STE 100 | ||||||||
Address2: |   | ||||||||
City: | ESCONDIDO | ||||||||
State: | CA | ||||||||
PostalCode: | 920254941 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7602916621 | ||||||||
FaxNumber: | 7607373430 | ||||||||
Practice Location | |||||||||
Address1: | 225 E 2ND AVE | ||||||||
Address2: |   | ||||||||
City: | ESCONDIDO | ||||||||
State: | CA | ||||||||
PostalCode: | 920254212 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8662282236 | ||||||||
FaxNumber: | 7607389047 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/09/2008 | ||||||||
LastUpdateDate: | 12/11/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/11/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 54416 | WI | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | A122406 | CA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 390200000X | 125052217 | IL | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   |
ID Information
ID | Type | State | Issuer | Description | PO1154749 | 01 | CA | MEDICARE RR | OTHER | GT641Z | 01 | CA | MEDICARE PTAN | OTHER |