MEDICARE: SOMONA LANDFAIR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374700000X	Technician

General Provider Information

NPI Number	:	1003599333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOMONA LANDFAIR

Provider Business Mailing Address
First Line	:	2501 RIVER OAKS BLVD APT 15D
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39211-3636
Country	:	US
Telephone Number	:	662-633-7445
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 RIVER OAKS BLVD APT 15D
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39211-3636
Country	:	US
Telephone Number	:	662-633-7445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2023
Last Update Date	:	08/11/2023

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Directions to “ SOMONA LANDFAIR ” Practice Location

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