Healthcare Provider Details

I. General information

NPI: 1528396710
Provider Name (Legal Business Name): BENJAMIN SOMMER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2009
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10737 CAMINO RUIZ
SAN DIEGO CA
92126-2359
US

IV. Provider business mailing address

637 3RD AVE
CHULA VISTA CA
91910-5707
US

V. Phone/Fax

Practice location:
  • Phone: 844-200-2426
  • Fax: 619-474-4008
Mailing address:
  • Phone: 844-200-2426
  • Fax: 619-356-2726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.144388
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2021-03446
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number259845
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6303
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2017034845
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number63171
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60775849
License Number StateWA
# 8
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number83761
License Number StateSC
# 9
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A16118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: