Provider Demographics
NPI:1598846594
Name:SPARKS, TAWNEY MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:TAWNEY
Middle Name:MARIE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 CALIFORNIA CITY BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CALIFORNIA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93505-2672
Mailing Address - Country:US
Mailing Address - Phone:760-373-7939
Mailing Address - Fax:
Practice Address - Street 1:8201 CALIFORNIA CITY BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:CALIFORNIA CITY
Practice Address - State:CA
Practice Address - Zip Code:93505-2672
Practice Address - Country:US
Practice Address - Phone:760-373-7939
Practice Address - Fax:661-823-8474
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4613171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist