Healthcare Provider Details

I. General information

NPI: 1720855505
Provider Name (Legal Business Name): SUMMITCARE MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1582 W SAN MARCOS BLVD STE 100
SAN MARCOS CA
92078-4081
US

IV. Provider business mailing address

3830 VALLEY CENTRE DR STE 705-832
SAN DIEGO CA
92130-3320
US

V. Phone/Fax

Practice location:
  • Phone: 442-222-1514
  • Fax: 949-841-1591
Mailing address:
  • Phone: 442-222-1514
  • Fax: 949-841-1591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BUSHRA JAFREY
Title or Position: MANAGER
Credential:
Phone: 442-222-1514