=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215476320
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUMMER DE LA GARZA NNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2017
-----------------------------------------------------
Last Update Date | 08/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6084 E 62ND AVE
-----------------------------------------------------
City | COMMERCE CITY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80022-3310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-732-0181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6084 E 62ND AVE
-----------------------------------------------------
City | COMMERCE CITY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80022-3310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-732-0181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WN0002X
-----------------------------------------------------
Taxonomy Name | Neonatal Intensive Care Registered Nurse
-----------------------------------------------------
License Number | 162661
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LN0000X
-----------------------------------------------------
Taxonomy Name | Neonatal Nurse Practitioner
-----------------------------------------------------
License Number | APN0993257-NP
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------