Provider Demographics
NPI:1407483704
Name:LAQUERRE, SUMMER RAY (CRNA)
Entity Type:Individual
Prefix:DR
First Name:SUMMER
Middle Name:RAY
Last Name:LAQUERRE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22555 WATERBURY ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-4924
Mailing Address - Country:US
Mailing Address - Phone:805-794-5350
Mailing Address - Fax:
Practice Address - Street 1:18840 VENTURA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3382
Practice Address - Country:US
Practice Address - Phone:805-794-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584615163W00000X
CA95001381367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse