MEDICARE: ALWYN TEANO SUMABAT MD

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	207Q00000X	Family Medicine Physician	A86384	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497836159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALWYN TEANO SUMABAT MD

Provider Business Mailing Address
First Line	:	710 N EUCLID ST
Second Line	:	SUITE 107
City	:	ANAHEIM
State	:	CA
Zip	:	92801-4122
Country	:	US
Telephone Number	:	714-533-4511
Fax Number	:	714-517-2110

Provider Business Practice Location Address
First Line	:	710 N EUCLID ST
Second Line	:	SUITE 107
City	:	ANAHEIM
State	:	CA
Zip	:	92801-4122
Country	:	US
Telephone Number	:	714-533-4511
Fax Number	:	714-517-2110

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	03/27/2023

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