Provider Demographics
NPI:1831656446
Name:SUMULONG, REY LANCE (CRNA)
Entity Type:Individual
Prefix:
First Name:REY
Middle Name:LANCE
Last Name:SUMULONG
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20545 VIA BELARMINO
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3128
Mailing Address - Country:US
Mailing Address - Phone:714-926-8203
Mailing Address - Fax:
Practice Address - Street 1:10408 INDUSTRIAL CIR
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4548
Practice Address - Country:US
Practice Address - Phone:909-796-7803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001086367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered