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1441 Superior Ave Ste F Newport Beach CA 92663-2704 | |
| (714) 494-1867 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 1441 Superior Ave, Newport Beach, California |
| Authorized Official Name and Position | Michael W Summerlin (PRESIDENT) |
| Authorized Official Contact | 9496773220 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1441 Superior Ave Ste F Newport Beach CA 92663-2704 Ph: (714) 494-1867 | 1441 Superior Ave Ste F Newport Beach CA 92663-2704 Ph: (714) 494-1867 |
| NPI Number | 1932450889 |
|---|---|
| Provider Enumeration Date | 10/01/2012 |
| Last Update Date | 05/30/2024 |
| Certification Date | 05/30/2024 |
| Medicare PECOS PAC ID | 7810258399 |
|---|---|
| Medicare Enrollment ID | O20180223002258 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932450889 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY28000 (California) | Primary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Michael W Summerlin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083745152 PECOS PAC ID: 0244514966 Enrollment ID: I20170224001010 |
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