Healthcare Provider Details

I. General information

NPI: 1184964637
Provider Name (Legal Business Name): SUZANNE M SOMMER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 MORAGA RD #101
LAFAYETTE CA
94549-4579
US

IV. Provider business mailing address

365 LENNON LN STE 250
WALNUT CREEK CA
94598-5915
US

V. Phone/Fax

Practice location:
  • Phone: 925-962-9120
  • Fax: 925-962-9122
Mailing address:
  • Phone: 925-948-8143
  • Fax: 925-948-8143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number7998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: