Provider Demographics
NPI:1780668178
Name:SPARKS, TRANG HUONG (PA)
Entity Type:Individual
Prefix:MRS
First Name:TRANG
Middle Name:HUONG
Last Name:SPARKS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TRANG
Other - Middle Name:HUONG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1601 MONTE VISTA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-6601
Mailing Address - Country:US
Mailing Address - Phone:909-865-2565
Mailing Address - Fax:909-865-2955
Practice Address - Street 1:795 E. SECOND STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2007
Practice Address - Country:US
Practice Address - Phone:909-865-2565
Practice Address - Fax:909-865-2955
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 14758363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 14758Medicaid
CAPA 14758Medicaid
CAWPA 14758AMedicare ID - Type Unspecified
CAWPA 14758BMedicare ID - Type Unspecified