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General NPI Number Information
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NPI Number | 1760426324
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Entity Type | Individual
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Provider Name | MARIVIC SUMULONG-TOMACRUZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 08/14/2013
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Provider Practice Location Address
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Address Line | 4101 SOUTH 4TH TRAFFICWAY
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City | LEAVENWORTH
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State | KS
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Zip | 66048
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Country | US
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Telephone | 913-682-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 3605 W. 154TH STREET
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City | LEAWOOD
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State | KS
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Zip | 66224
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Country | US
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Telephone | 913-239-0314
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 04-26592
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License Number State | KS
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