Provider Demographics
NPI:1518128123
Name:SASPORTAS, FREDERICK
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:SASPORTAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61607 29 PALMS HWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:JOSHUA TREE
Mailing Address - State:CA
Mailing Address - Zip Code:92252-2391
Mailing Address - Country:US
Mailing Address - Phone:760-366-8641
Mailing Address - Fax:760-366-3365
Practice Address - Street 1:61607 29 PALMS HWY
Practice Address - Street 2:SUITE D
Practice Address - City:JOSHUA TREE
Practice Address - State:CA
Practice Address - Zip Code:92252-2391
Practice Address - Country:US
Practice Address - Phone:760-366-8641
Practice Address - Fax:760-366-3365
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)