Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Spark Physician Assistant Services, Inc

Organization Psychiatry Physician · NPI 1760093454

Spark Physician Assistant Services, Inc is a Psychiatry Physician in San Pedro, California. Registered with an NPI since 2020.

In the registry since
2020
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3031 S Denison Ave
San Pedro, CA 90731-6703
Phone: (323) 379-3611
Fax: (786) 629-6142
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X

Record details

NPI number1760093454
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Christina Ribao — Owner · (323) 379-3611
Other names Spark Psychedelic Therapy; Spark Psychedelic Therapy; Spark Therapeutics
NPI enumeratedAugust 14, 2020
Last updated in NPPESSeptember 8, 2020
Certification dateSeptember 8, 2020
Mailing address3031 S Denison Ave, San Pedro, CA 90731-6703

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