Provider Demographics
NPI:1740414838
Name:SUMMERLIN, ELENA RINA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ELENA
Middle Name:RINA
Last Name:SUMMERLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28585 DAWN LN
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-9529
Mailing Address - Country:US
Mailing Address - Phone:951-973-3484
Mailing Address - Fax:
Practice Address - Street 1:4765 CARMEL MOUNTAIN RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-6657
Practice Address - Country:US
Practice Address - Phone:858-259-0553
Practice Address - Fax:858-259-0518
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA20130363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical