Provider Demographics
NPI:1154312577
Name:SUMMERS, MONICA (PA)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WILSON RD
Mailing Address - Street 2:STE 100
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7885
Mailing Address - Country:US
Mailing Address - Phone:831-242-8392
Mailing Address - Fax:
Practice Address - Street 1:1212 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2260
Practice Address - Country:US
Practice Address - Phone:831-422-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15364363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA153640OtherBLUE SHIELD
CAOPA153640Medicaid
CAOPA153640OtherBLUE SHIELD
P50245Medicare UPIN
CAOPA153640Medicaid