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Organization
SPARK PHYSICIAN ASSISTANT SERVICES, INC.
Active
Organization
SPARK PHYSICIAN ASSISTANT SERVICES, INC.
Active
Other names
Spark Psychedelic Therapy, Spark Therapeutics
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINA RIBAO PA-C (OWNER)
(323) 379-3611
Entity
Organization
Contact information
Practice address
3031 S DENISON AVE, SAN PEDRO, CA 90731-6703
(323) 379-3611
(786) 629-6142
Mailing address
3031 S DENISON AVE, SAN PEDRO, CA 90731-6703
(786) 599-0360
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
08/14/2020
Last updated
09/08/2020
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