Provider Demographics
NPI:1043772734
Name:SUMMERS STROMBERG, JACQUELINE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ELIZABETH
Last Name:SUMMERS STROMBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ELIZABETH
Other - Last Name:SUMMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DRIVE, LANE 154
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5133
Mailing Address - Country:US
Mailing Address - Phone:650-723-6661
Mailing Address - Fax:650-498-6205
Practice Address - Street 1:300 PASTEUR DRIVE, LANE 154
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5133
Practice Address - Country:US
Practice Address - Phone:650-723-6661
Practice Address - Fax:650-498-6205
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program