Healthcare Provider Details

I. General information

NPI: 1124427240
Provider Name (Legal Business Name): MRS. SUMMER MAREE TRONGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000B S CENTER DR
CLEARLAKE CA
95422-8131
US

IV. Provider business mailing address

PO BOX 1024
LUCERNE CA
95458-1024
US

V. Phone/Fax

Practice location:
  • Phone: 707-994-7090
  • Fax: 707-994-7092
Mailing address:
  • Phone: 707-994-7090
  • Fax: 707-994-7092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: