MEDICARE: BERNICE A SPARKS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	395715	CA

General Provider Information

NPI Number	:	1205762531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNICE A SPARKS RN

Provider Business Mailing Address
First Line	:	15111 FREEMAN AVE UNIT 48
Second Line	:
City	:	LAWNDALE
State	:	CA
Zip	:	90260-2163
Country	:	US
Telephone Number	:	310-597-1530
Fax Number	:

Provider Business Practice Location Address
First Line	:	11301 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90073-1003
Country	:	US
Telephone Number	:	310-597-1530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2026
Last Update Date	:	06/23/2026

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