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General NPI Number Information
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NPI Number | 1740099811
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Entity Type | Organization
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Legal Business Name | SPARKS ASSOCIATES MEDICAL GROUP INC
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 3111 FITE CIR STE 103
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City | SACRAMENTO
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State | CA
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Zip | 95827-1813
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Country | US
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Telephone | 916-362-5112
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Fax |
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Provider Business Mailing Address
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Address Line | 3111 FITE CIR STE 103
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City | SACRAMENTO
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State | CA
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Zip | 95827-1813
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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 | OWNER
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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 | 202C00000X
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Taxonomy Name | Independent Medical Examiner Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 209800000X
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Taxonomy Name | Legal Medicine (M.D./D.O.) Physician
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License Number |
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License Number State |
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