Provider Demographics
NPI:1528749751
Name:DR. SARPOMA MD INC
Entity type:Organization
Organization Name:DR. SARPOMA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAMIE
Authorized Official - Middle Name:SARPOMA
Authorized Official - Last Name:SEFA-BOAKYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-210-6138
Mailing Address - Street 1:211 BROOKS ST UNIT 1545
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92051-7024
Mailing Address - Country:US
Mailing Address - Phone:619-202-5663
Mailing Address - Fax:
Practice Address - Street 1:2420 VISTA WAY STE 102
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6190
Practice Address - Country:US
Practice Address - Phone:619-202-5663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty