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General NPI Number Information
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NPI Number | 1679749998
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Entity Type | Organization
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Legal Business Name | GUILLERMO SOMODEVILLA MD PA
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 7805 CORAL WAY #126
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City | MIAMI
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State | FL
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Zip | 33155-6539
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Country | US
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Telephone | 305-269-0385
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Fax | 305-269-0386
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Provider Business Mailing Address
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Address Line | 7805 CORAL WAY #126
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City | MIAMI
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State | FL
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Zip | 33155-6539
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Country | US
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Telephone | 305-269-0385
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Fax | 305-269-0386
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GUILLERMO SOMODEVILLA
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Credential | M.D.
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Telephone | 305-269-0385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME0049294
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License Number State | FL
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