Provider Demographics
NPI:1316162167
Name:SUMNER, STAYSEA (LAC PHD)
Entity type:Individual
Prefix:
First Name:STAYSEA
Middle Name:
Last Name:SUMNER
Suffix:
Gender:F
Credentials:LAC PHD
Other - Prefix:
Other - First Name:STAYSEA
Other - Middle Name:
Other - Last Name:SUMNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MTOM, PHD
Mailing Address - Street 1:28633 S WESTERN AVE
Mailing Address - Street 2:#202
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-0827
Mailing Address - Country:US
Mailing Address - Phone:310-241-0947
Mailing Address - Fax:
Practice Address - Street 1:28633 S WESTERN AVE
Practice Address - Street 2:#202
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0827
Practice Address - Country:US
Practice Address - Phone:310-241-0947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10658171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist