Provider Demographics
NPI:1295064376
Name:SUMADCHAT, MARGUERITE GOZUN (PT)
Entity type:Individual
Prefix:MS
First Name:MARGUERITE
Middle Name:GOZUN
Last Name:SUMADCHAT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13572 GOLDMEDAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-8349
Mailing Address - Country:US
Mailing Address - Phone:818-585-1891
Mailing Address - Fax:818-626-3124
Practice Address - Street 1:13572 GOLDMEDAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-8349
Practice Address - Country:US
Practice Address - Phone:818-585-1891
Practice Address - Fax:818-626-3124
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37777174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist