Provider Demographics
NPI:1407134604
Name:PEREZ, SUMMER RAENAE (SFIDC)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:RAENAE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 BLUE BELL LN
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-8648
Mailing Address - Country:US
Mailing Address - Phone:760-402-2353
Mailing Address - Fax:
Practice Address - Street 1:816 BLUE BELL LN
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-8648
Practice Address - Country:US
Practice Address - Phone:760-402-2353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman