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NPI Code Detail

MEDICARE: SUMMER DAVIDSON GOMEZ LCSW

MEDICARE: SUMMER DAVIDSON GOMEZ LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker25416CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1#95-2633765OTHERCAMEDI-CAL

General Provider Information

NPI Number : 1073684536
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUMMER DAVIDSON GOMEZ LCSW
Provider Business Mailing Address
First Line : 2450 S ATLANTIC BLVD STE 101
Second Line :
City : COMMERCE
State : CA
Zip : 90040-1200
Country : US
Telephone Number : 323-318-9960
Fax Number : 323-780-3211
Provider Business Practice Location Address
First Line : 5628 E SLAUSON AVE
Second Line :
City : COMMERCE
State : CA
Zip : 90040-2922
Country : US
Telephone Number : 818-588-1583
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2006
Last Update Date : 10/09/2018

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