MEDICARE: TAWNEY MARIE SPARKS LAC

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	171100000X	Acupuncturist	AC4613	CA

General Provider Information

NPI Number	:	1598846594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAWNEY MARIE SPARKS LAC

Provider Business Mailing Address
First Line	:	8201 CALIFORNIA CITY BLVD
Second Line	:	SUITE D
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-2672
Country	:	US
Telephone Number	:	760-373-7939
Fax Number	:

Provider Business Practice Location Address
First Line	:	8201 CALIFORNIA CITY BLVD
Second Line	:	SUITE D
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-2672
Country	:	US
Telephone Number	:	760-373-7939
Fax Number	:	661-823-8474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/31/2013

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