Healthcare Provider Details

I. General information

NPI: 1477829802
Provider Name (Legal Business Name): NILI BETH SOMMOVILLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW RM G-3041
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

1250 16TH ST STE 2304
SANTA MONICA CA
90404-1249
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-3976
  • Fax: 202-444-5104
Mailing address:
  • Phone: 310-319-4698
  • Fax: 310-206-3260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDC045067
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: