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General NPI Number Information
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NPI Number | 1073805784
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Entity Type | Organization
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Legal Business Name | SUMMIT MEDICAL
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 21520 PIONEER BLVD STE 203
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City | HAWAIIAN GARDENS
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State | CA
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Zip | 90716-2601
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Country | US
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Telephone | 877-333-5036
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Fax | 877-333-5037
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Provider Business Mailing Address
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Address Line | 21520 PIONEER BLVD STE 203
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City | HAWAIIAN GARDENS
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State | CA
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Zip | 90716-2601
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Country | US
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Telephone | 877-333-5036
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Fax | 877-333-5037
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTINA HERNANDEZ
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Credential |
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Telephone | 877-333-5036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State | CA
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