Tyler Collin Sparks
Individual provider Active NPI Independent Duty Corpsman · Camp Pendletion, CA
NPI 1639782899 · NPPES record last updated Aug 27, 2020
Key facts
- NPI
- 1639782899
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Independent Duty Corpsman 1710I1002X
- Practice address
- 1 MRB
Camp Pendletion, CA 92055 - Phone
- (760) 725-5298
- NPI assigned
- Aug 27, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Duty Corpsman | 1710I1002X | CA | Yes |
Addresses
Primary practice location
1 MRB
Camp Pendletion, CA 92055
Mailing address
PO Box 555341
Camp Pendleton, CA 92055-5341
Phone (760) 725-5298
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.