Provider Demographics
NPI:1487129268
Name:PIMENTEL, SUMMER MARIE
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:MARIE
Last Name:PIMENTEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14964 SEQUOIA ST APT 13
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1609
Mailing Address - Country:US
Mailing Address - Phone:442-229-3908
Mailing Address - Fax:
Practice Address - Street 1:14964 SEQUOIA ST APT 13
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1609
Practice Address - Country:US
Practice Address - Phone:442-229-3908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst