Healthcare Provider Details

I. General information

NPI: 1700757028
Provider Name (Legal Business Name): MICHAEL ANTHONY SOMERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 TULLY RD
MODESTO CA
95350-0811
US

IV. Provider business mailing address

13717 S UNION RD
MANTECA CA
95336-9281
US

V. Phone/Fax

Practice location:
  • Phone: 209-576-2283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: