Healthcare Provider Details

I. General information

NPI: 1487977286
Provider Name (Legal Business Name): HEATH JACOB SOMMER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MDOS/SOGW
TRAVIS AFB CA
94535
US

IV. Provider business mailing address

421 PALIN AVE
GALT CA
95632-1618
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-5174
  • Fax:
Mailing address:
  • Phone: 916-995-8928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-202423
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: