Healthcare Provider Details

I. General information

NPI: 1902710510
Provider Name (Legal Business Name): SPARK DIGITAL TECHNOLOGIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3507 ASHLOCK DR
HOUSTON TX
77082-5505
US

IV. Provider business mailing address

3507 ASHLOCK DR
HOUSTON TX
77082-5505
US

V. Phone/Fax

Practice location:
  • Phone: 213-259-3057
  • Fax:
Mailing address:
  • Phone: 213-259-3057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. ROBERT RUSSELL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 213-259-3057