Provider Demographics
NPI:1134321144
Name:SUMMIT MEDICAL MANAGEMENT
Entity Type:Organization
Organization Name:SUMMIT MEDICAL MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FARIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHAMATI
Authorized Official - Suffix:
Authorized Official - Credentials:PT,OMD
Authorized Official - Phone:310-203-9292
Mailing Address - Street 1:7040 TRASK AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-2622
Mailing Address - Country:US
Mailing Address - Phone:714-901-4399
Mailing Address - Fax:714-890-6012
Practice Address - Street 1:7040 TRASK AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-2622
Practice Address - Country:US
Practice Address - Phone:714-901-4399
Practice Address - Fax:714-890-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 3471171100000X
CAPT11796225100000X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty