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Organization
SPARTAMED
Active
Organization
SPARTAMED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TREVOR THERIOT (PRESIDENT)
(657) 266-0069
Entity
Organization
Contact information
Practice address
1511 W ALTON AVE, SANTA ANA, CA 92704-7219
(949) 632-0355
Mailing address
1511 W ALTON AVE, SANTA ANA, CA 92704-7219
(657) 266-0069
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
103-035557
CA
Other
Enumeration date
07/24/2017
Last updated
07/24/2017
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