Individual
TYLER COLLIN SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 MRB, CAMP PENDLETION, CA 92055
(760) 725-5298
Mailing address
PO BOX 555341, CAMP PENDLETON, CA 92055-5341
(760) 725-5298
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
CA
Other
Enumeration date
08/27/2020
Last updated
08/27/2020
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