Provider Demographics
NPI:1780476374
Name:SUMETAWENUNT, WARAPHAN
Entity type:Individual
Prefix:
First Name:WARAPHAN
Middle Name:
Last Name:SUMETAWENUNT
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 1:301 MERCEDES ST APT 10303
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-2665
Mailing Address - Country:US
Mailing Address - Phone:210-847-1534
Mailing Address - Fax:
Practice Address - Street 1:1400 E US HIGHWAY 377
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2646
Practice Address - Country:US
Practice Address - Phone:682-498-4143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program