MEDICARE: SIVANNA RUTH SOMMERVILLE

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	146N00000X	Basic Emergency Medical Technician

General Provider Information

NPI Number	:	1366380297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIVANNA RUTH SOMMERVILLE

Provider Business Mailing Address
First Line	:	721 SEASIDE ST
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-4716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 SEASIDE ST
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-4716
Country	:	US
Telephone Number	:	831-588-0279
Fax Number	:

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

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “ SIVANNA RUTH SOMMERVILLE ” Practice Location

Language	Start Address	Practice Location

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