Healthcare Provider Details

I. General information

NPI: 1801564729
Provider Name (Legal Business Name): RONALD SUMRALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 2ND ST APT 208
SANTA MONICA CA
90403-3622
US

IV. Provider business mailing address

1029 2ND ST APT 208
SANTA MONICA CA
90403-3622
US

V. Phone/Fax

Practice location:
  • Phone: 214-620-0323
  • Fax:
Mailing address:
  • Phone: 214-620-0323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14280971-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119740
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL18532
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: