Provider Demographics
NPI:1700610821
Name:SUMMIT HEALTH SPA
Entity type:Organization
Organization Name:SUMMIT HEALTH SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE LYNN KIMBERLY
Authorized Official - Middle Name:SIY
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-817-1761
Mailing Address - Street 1:19000 HAWTHORNE BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1517
Mailing Address - Country:US
Mailing Address - Phone:818-817-1761
Mailing Address - Fax:
Practice Address - Street 1:19000 HAWTHORNE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1517
Practice Address - Country:US
Practice Address - Phone:818-817-1761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center