| Sparcc Professional Corporation | |
|
5199 E Farness Dr Ste 101 Tucson AZ 85712-5617 | |
| (520) 222-8076 | |
| (520) 300-7156 |
| Full Name | Sparcc Professional Corporation |
|---|---|
| Speciality | Pediatrics |
| Location | 5199 E Farness Dr, Tucson, Arizona |
| Authorized Official Name and Position | Mohammed Mortazavi (DIRECTOR) |
| Authorized Official Contact | 5202228076 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sparcc Professional Corporation 5199 E Farness Dr Ste 101 Tucson AZ 85712-5617 Ph: (520) 548-4847 | Sparcc Professional Corporation 5199 E Farness Dr Ste 101 Tucson AZ 85712-5617 Ph: (520) 222-8076 |
| NPI Number | 1003275413 |
|---|---|
| Provider Enumeration Date | 02/12/2016 |
| Last Update Date | 05/13/2025 |
| Medicare PECOS PAC ID | 8820515539 |
|---|---|
| Medicare Enrollment ID | O20250506003405 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003275413 | NPI | - | NPPES |
| Provider Name | Mohammed Raheeb Mortazavi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1871740241 PECOS PAC ID: 8820240203 Enrollment ID: I20140814001227 |
| Provider Name | Brett Cordyn Wood Dusenberry |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1104274430 PECOS PAC ID: 6406219401 Enrollment ID: I20250612002103 |
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