Tyler Collin Sparks
Military Health Care Provider, Independent Duty Corpsman in Camp Pendletion, CA. Individual provider (NPI-1).
NPI number1639782899
StatusActive
Last updated in NPPESAug 27, 2020
Details
- NPI
- 1639782899
- Entity type
- Individual (NPI-1)
- Name
- Tyler Collin Sparks
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 27, 2020
- Certification date
- Aug 24, 2020
- Last updated
- Aug 27, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1710I1002X | Military Health Care Provider, Independent Duty Corpsman | – | CA | Yes |
Practice location
1 MrbCamp Pendletion, CA 92055
Phone 760-725-5298
Mailing address
Po Box 555341Camp Pendleton, CA 92055-5341
Phone 760-725-5298
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