Healthcare Provider Details

I. General information

NPI: 1760409742
Provider Name (Legal Business Name): SUMMER R YOUKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 J ST STE 100
SACRAMENTO CA
95816-4307
US

IV. Provider business mailing address

2805 J ST STE 100
SACRAMENTO CA
95816-4307
US

V. Phone/Fax

Practice location:
  • Phone: 916-492-1828
  • Fax: 916-492-1834
Mailing address:
  • Phone: 916-492-1828
  • Fax: 916-492-1834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberC53335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: