Provider Demographics
NPI:1447270145
Name:SOMMER, BRENT (CRNA)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:SOMMER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 NOE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-1923
Mailing Address - Country:US
Mailing Address - Phone:415-642-1170
Mailing Address - Fax:415-642-1170
Practice Address - Street 1:1348 NOE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-1923
Practice Address - Country:US
Practice Address - Phone:415-642-1170
Practice Address - Fax:415-642-1171
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACRNA1000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN2750240Medicaid
CARN2750240Medicaid