Provider Demographics
NPI:1417634932
Name:SUMMERS, ALLEN (CNA)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 VIA MARIPOSA E UNIT N
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-2227
Mailing Address - Country:US
Mailing Address - Phone:310-877-0620
Mailing Address - Fax:
Practice Address - Street 1:6816 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-1922
Practice Address - Country:US
Practice Address - Phone:213-312-5529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01138299376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide