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General NPI Number Information
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NPI Number | 1609218023
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Entity Type | Individual
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Provider Name | TANAYA SPARKLE M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/26/2013
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 501 S BUENA VISTA ST
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City | BURBANK
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State | CA
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Zip | 91505-4809
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Country | US
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Telephone | 773-875-5610
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Fax |
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Provider Business Mailing Address
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Address Line | 12105 FALCON CREST WAY
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City | PORTER RANCH
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State | CA
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Zip | 91326-3896
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Country | US
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Telephone | 773-875-5610
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Fax | 773-875-5610
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 35.133371
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | C196215
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License Number State | CA
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