# SPARTAMED

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467975284
- **Authorized official:** TREVOR THERIOT (PRESIDENT)
- **Authorized official phone:** (657) 266-0069

## Contact information

- **Practice address:** 1511 W ALTON AVE, SANTA ANA, CA 92704-7219
- **Practice address phone:** (949) 632-0355
- **Mailing address:** 1511 W ALTON AVE, SANTA ANA, CA 92704-7219
- **Mailing address phone:** (657) 266-0069

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | 103-035557 | CA | Yes |

## Other

- **Enumeration date:** 07/24/2017
- **Last updated:** 07/24/2017