MEDICARE: ISAAC JOEL SUMALJAG

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1215883590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAAC JOEL SUMALJAG

Provider Business Mailing Address
First Line	:	2500 BOBCAT VILLAGE CENTER RD UNIT G
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8476
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 BOBCAT VILLAGE CENTER RD UNIT G
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8476
Country	:	US
Telephone Number	:	239-778-6574
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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