NPIMap

Organization Active NPI

Spark Physician Assistant Services, Inc.

  • Psychiatry Physician
  • San Pedro, CA
National Provider Identifier
1760093454
Registry record updated Sep 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SPARK PHYSICIAN ASSISTANT SERVICES, INC.
Practice address
3031 S Denison Ave
San Pedro, CA 90731-6703
Phone
(323) 379-3611
Fax
(786) 629-6142
NPI assigned
Aug 14, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christina Ribao, PA-C
Title
Owner
Phone
(323) 379-3611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

3031 S Denison Ave
San Pedro, CA 90731-6703

Mailing address

3031 S Denison Ave
San Pedro, CA 90731-6703
Phone (786) 599-0360

Other names 2

  • Spark Psychedelic Therapy Doing business as
  • Spark Therapeutics Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1760093454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3031 S DENISON AVE",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907316703",
            "telephone_number": "786-599-0360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3031 S DENISON AVE",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907316703",
            "telephone_number": "323-379-3611",
            "fax_number": "786-629-6142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARK PHYSICIAN ASSISTANT SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-14",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A",
        "authorized_official_last_name": "RIBAO",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "323-379-3611",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spark Psychedelic Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spark Psychedelic Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spark Therapeutics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Pedro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.