Provider Demographics
NPI:1073805784
Name:SUMMIT MEDICAL
Entity Type:Organization
Organization Name:SUMMIT MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-333-5036
Mailing Address - Street 1:21520 PIONEER BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:HAWAIIAN GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90716-2601
Mailing Address - Country:US
Mailing Address - Phone:877-333-5036
Mailing Address - Fax:877-333-5037
Practice Address - Street 1:21520 PIONEER BLVD STE 203
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-2601
Practice Address - Country:US
Practice Address - Phone:877-333-5036
Practice Address - Fax:877-333-5037
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT MEDICAL EQUIPMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty