Provider Demographics
NPI:1467531988
Name:SUMMERFIELD, MERILEE R (PA)
Entity Type:Individual
Prefix:
First Name:MERILEE
Middle Name:R
Last Name:SUMMERFIELD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10225 AUSTIN DR
Mailing Address - Street 2:STE# 101
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1500
Mailing Address - Country:US
Mailing Address - Phone:619-660-6003
Mailing Address - Fax:619-660-0296
Practice Address - Street 1:10225 AUSTIN DR
Practice Address - Street 2:STE #101
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1500
Practice Address - Country:US
Practice Address - Phone:619-660-6003
Practice Address - Fax:619-660-0296
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA14929OtherPA LICENSE