Provider Demographics
NPI:1164072344
Name:MALIMBAN, STACY SUMMER CANTERO (DC)
Entity Type:Individual
Prefix:
First Name:STACY SUMMER
Middle Name:CANTERO
Last Name:MALIMBAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 DAWSON DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-7024
Mailing Address - Country:US
Mailing Address - Phone:858-302-8334
Mailing Address - Fax:
Practice Address - Street 1:1279 DAWSON DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-7024
Practice Address - Country:US
Practice Address - Phone:858-302-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor