MEDICARE: SPARCC PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner
2	2080S0010X	Pediatric Sports Medicine Physician	49421	AZ
3	363A00000X	Physician Assistant
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
5	225X00000X	Occupational Therapist
6	152W00000X	Optometrist
7	225100000X	Physical Therapist
8	207RS0010X	Sports Medicine (Internal Medicine) Physician	49421	AZ

General Provider Information

NPI Number	:	1003275413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARCC PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	5199 E FARNESS DR STE 101
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2262
Country	:	US
Telephone Number	:	520-548-4847
Fax Number	:	520-300-7156

Provider Business Practice Location Address
First Line	:	5199 E FARNESS DR
Second Line	:	STE 101
City	:	TUCSON
State	:	AZ
Zip	:	85712-5617
Country	:	US
Telephone Number	:	520-222-8076
Fax Number	:	520-300-7156

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. MOHAMMED MORTAZAVI
Credential	:	MD
Telephone Number	:	520-222-8076

Provider Enumeration Date	:	02/12/2016
Last Update Date	:	03/17/2026

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Directions to “SPARCC PROFESSIONAL CORPORATION ” Practice Location

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