Healthcare Provider Details

I. General information

NPI: 1316291024
Provider Name (Legal Business Name): TARYN ELIZABETH SOMMERS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARYN ELIZABETH STOLPP PA

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 E ONTARIO AVE STE 101
CORONA CA
92879-3508
US

IV. Provider business mailing address

947 CHINOTTO CIR
CORONA CA
92881-8390
US

V. Phone/Fax

Practice location:
  • Phone: 951-371-2411
  • Fax: 951-284-0177
Mailing address:
  • Phone: 951-833-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number22644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: