Healthcare Provider Details

I. General information

NPI: 1295649978
Provider Name (Legal Business Name): SUMMER VAZIRALLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 HILLSIDE DR
WEED CA
96094-2415
US

IV. Provider business mailing address

909 HILLSIDE DR
WEED CA
96094-2499
US

V. Phone/Fax

Practice location:
  • Phone: 530-925-0505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240092969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: