Provider Demographics
NPI:1376849281
Name:SUM TRAN MD INC
Entity Type:Organization
Organization Name:SUM TRAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-253-2211
Mailing Address - Street 1:23823 VALENCIA BLVD
Mailing Address - Street 2:#220
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2103
Mailing Address - Country:US
Mailing Address - Phone:661-253-2211
Mailing Address - Fax:661-253-0016
Practice Address - Street 1:23823 VALENCIA BLVD
Practice Address - Street 2:#220
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2103
Practice Address - Country:US
Practice Address - Phone:661-253-2211
Practice Address - Fax:661-253-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA327532082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A307530Medicaid
CAA26921Medicare UPIN