Healthcare Provider Details

I. General information

NPI: 1740414838
Provider Name (Legal Business Name): ELENA RINA SUMMERLIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4765 CARMEL MOUNTAIN RD STE 102
SAN DIEGO CA
92130-6657
US

IV. Provider business mailing address

28585 DAWN LN
WINCHESTER CA
92596-9529
US

V. Phone/Fax

Practice location:
  • Phone: 858-259-0553
  • Fax: 858-259-0518
Mailing address:
  • Phone: 951-973-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA20130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: