Provider Demographics
NPI:1497836159
Name:SUMABAT, ALWYN TEANO (MD)
Entity Type:Individual
Prefix:
First Name:ALWYN
Middle Name:TEANO
Last Name:SUMABAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N EUCLID ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4122
Mailing Address - Country:US
Mailing Address - Phone:714-533-4511
Mailing Address - Fax:714-517-2110
Practice Address - Street 1:710 N EUCLID ST
Practice Address - Street 2:SUITE 107
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4122
Practice Address - Country:US
Practice Address - Phone:714-533-4511
Practice Address - Fax:714-517-2110
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA86384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A863840Medicaid
CAWA86384AMedicare PIN