Healthcare Provider Details

I. General information

NPI: 1710088083
Provider Name (Legal Business Name): EUGENE SOMOZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE ST
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

3210 JEFFERSON AVE SUITE #6
CINCINNATI OH
45220-2272
US

V. Phone/Fax

Practice location:
  • Phone: 513-487-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number35050249
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: