Provider Demographics
NPI:1053480780
Name:SUMAQUIAL, MARIETTA ABELLERA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIETTA
Middle Name:ABELLERA
Last Name:SUMAQUIAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95201-0779
Mailing Address - Country:US
Mailing Address - Phone:209-373-2800
Mailing Address - Fax:209-373-2873
Practice Address - Street 1:2401 W TURNER RD
Practice Address - Street 2:SUITE 450
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-2182
Practice Address - Country:US
Practice Address - Phone:209-370-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA884534Medicare UPIN