Provider Demographics
NPI:1346993029
Name:SPORA MEDICAL, P.C.
Entity Type:Organization
Organization Name:SPORA MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-389-1899
Mailing Address - Street 1:548 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-5401
Mailing Address - Country:US
Mailing Address - Phone:773-389-1899
Mailing Address - Fax:
Practice Address - Street 1:548 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-5401
Practice Address - Country:US
Practice Address - Phone:773-389-1899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care