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General NPI Number Information
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NPI Number | 1093514101
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Entity Type | Organization
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Legal Business Name | SPARKS MEDICAL CORP
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 8906 SAN BERNARDINO RD STE 140
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-8806
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Country | US
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Telephone | 909-204-2797
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10173
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City | TORRANCE
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State | CA
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Zip | 90505-0973
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHAD SPARKS
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Credential | MD
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Telephone | 310-956-9980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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