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NPI Code Detail

MEDICARE: SPARKLE WAFER

MEDICARE: SPARKLE WAFER
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1396569497
Entity Type Code : Individual
Provider Name (Legal Business Name) : SPARKLE WAFER
Provider Business Mailing Address
First Line : 77711 FLORA RD # 327
Second Line :
City : PALM DESERT
State : CA
Zip : 92211-4103
Country : US
Telephone Number : 800-465-3203
Fax Number : 888-588-2752
Provider Business Practice Location Address
First Line : 77711 FLORA RD STE 327
Second Line :
City : PALM DESERT
State : CA
Zip : 92211-4103
Country : US
Telephone Number : 800-465-3203
Fax Number : 888-588-2752
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2024
Last Update Date : 04/16/2026

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Directions to “ SPARKLE WAFER ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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