Healthcare Provider Details

I. General information

NPI: 1295654341
Provider Name (Legal Business Name): SUMMIT SURGICAL PHYSICIAN ASSISTANT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W EL CAMINO REAL
MOUNTAIN VIEW CA
94040-1335
US

IV. Provider business mailing address

1471 EL CAMINO REAL
BELMONT CA
94002-3909
US

V. Phone/Fax

Practice location:
  • Phone: 650-346-3132
  • Fax:
Mailing address:
  • Phone: 650-346-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA RUSCH
Title or Position: OWNER
Credential: PA-C
Phone: 650-346-3133