Healthcare Provider Details

I. General information

NPI: 1114417425
Provider Name (Legal Business Name): RASHMI PRIYA SOMU MBBS, MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15248 ELEVENTH ST
VICTORVILLE CA
92395-3704
US

IV. Provider business mailing address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

V. Phone/Fax

Practice location:
  • Phone: 760-843-6132
  • Fax: 760-843-6050
Mailing address:
  • Phone: 714-509-3519
  • Fax: 714-509-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA174693
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA174693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: