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General NPI Number Information
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NPI Number | 1891140638
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Entity Type | Individual
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Provider Name | FREDERICK SARPONG FNP
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Gender | Male
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 1215 N WABASH AVE
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City | REDLANDS
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State | CA
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Zip | 92374-4963
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Country | US
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Telephone | 909-794-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 1278 E LATHAM AVE
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City | HEMET
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State | CA
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Zip | 92543-4445
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Country | US
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Telephone | 909-794-0200
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP95004084
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License Number State | CA
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