Provider Demographics
NPI:1376973446
Name:CALIFORNIA SPORTS CONCUSSION
Entity Type:Organization
Organization Name:CALIFORNIA SPORTS CONCUSSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SOMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-582-0007
Mailing Address - Street 1:2345 ERRINGER RD
Mailing Address - Street 2:210
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2235
Mailing Address - Country:US
Mailing Address - Phone:805-582-0007
Mailing Address - Fax:
Practice Address - Street 1:2345 ERRINGER RD
Practice Address - Street 2:210
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2235
Practice Address - Country:US
Practice Address - Phone:805-582-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24620261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU633047Medicare UPIN