Individual provider · Type 1 NPI

Kandavin Sumilat

Family Nurse Practitioner · San Bernardino, CA

NPI number 1609457753 Active

Practice location

2195 Club Center Dr Ste A
San Bernardino, CA 92408-4162

Mailing address

PO Box 10069
San Bernardino, CA 92423-0069

Specialties and licenses

TaxonomyCodeLicense
Family Nurse Practitioner Primary 363LF0000X95022634 (CA)

Family Nurse Practitioner: Definition to come...

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About NPI 1609457753

Kandavin Sumilat's National Provider Identifier is 1609457753, issued on Apr 20, 2021. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in San Bernardino, CA. The record was last updated on Jun 9, 2026.