Provider Demographics
NPI:1932796869
Name:SUMERLIN, CRISTAL ANN (PA-C)
Entity type:Individual
Prefix:
First Name:CRISTAL
Middle Name:ANN
Last Name:SUMERLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CRISTAL
Other - Middle Name:ANN
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10245 HOLDER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10245 HOLDER WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2511
Practice Address - Country:US
Practice Address - Phone:928-242-4215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical