Healthcare Provider Details

I. General information

NPI: 1679670558
Provider Name (Legal Business Name): CAROL J SPAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 WESTWOOD BLVD SUITE 211
LOS ANGELES CA
90024-2945
US

IV. Provider business mailing address

941 WESTWOOD BLVD SUITE 211
LOS ANGELES CA
90024-2945
US

V. Phone/Fax

Practice location:
  • Phone: 310-824-2957
  • Fax: 310-824-0974
Mailing address:
  • Phone: 310-824-2957
  • Fax: 310-824-0974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG34646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: