Provider Demographics
NPI:1316291024
Name:SOMMERS, TARYN ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:ELIZABETH
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TARYN
Other - Middle Name:ELIZABETH
Other - Last Name:STOLPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:947 CHINOTTO CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8390
Mailing Address - Country:US
Mailing Address - Phone:951-833-2440
Mailing Address - Fax:
Practice Address - Street 1:260 E ONTARIO AVE STE 101
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3508
Practice Address - Country:US
Practice Address - Phone:951-371-2411
Practice Address - Fax:951-284-0177
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22644363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant