Provider Demographics
NPI:1801089784
Name:WENDY A SHUMATE MD
Entity type:Organization
Organization Name:WENDY A SHUMATE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHUMATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-630-4715
Mailing Address - Street 1:105 DURIAN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6205
Mailing Address - Country:US
Mailing Address - Phone:760-630-4715
Mailing Address - Fax:760-630-4249
Practice Address - Street 1:105 DURIAN ST
Practice Address - Street 2:SUITE A
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6205
Practice Address - Country:US
Practice Address - Phone:760-630-4715
Practice Address - Fax:760-630-4249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15915Medicare PIN