Provider Demographics
NPI:1679293088
Name:SUMMERS, JOHN DAVID ALLEN
Entity Type:Individual
Prefix:
First Name:JOHN DAVID
Middle Name:ALLEN
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44-103E PUUOHALAI PL
Mailing Address - Street 2:
Mailing Address - City:KANE'OHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744
Mailing Address - Country:US
Mailing Address - Phone:918-886-2980
Mailing Address - Fax:
Practice Address - Street 1:905 KALANIANAOLE HWY SPC 5001
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4669
Practice Address - Country:US
Practice Address - Phone:808-247-2973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician