Provider Demographics
NPI:1811900475
Name:SPARAGO, MERRILL TREMAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:MERRILL
Middle Name:TREMAYNE
Last Name:SPARAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 W OLYMPIC BLVD STE 578
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4259
Mailing Address - Country:US
Mailing Address - Phone:310-231-8905
Mailing Address - Fax:310-231-8963
Practice Address - Street 1:11500 W OLYMPIC BLVD STE 578
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4259
Practice Address - Country:US
Practice Address - Phone:310-231-8905
Practice Address - Fax:310-231-8963
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA771852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A771850OtherMEDICAL