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General NPI Number Information
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NPI Number | 1972923134
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Entity Type | Individual
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Provider Name | YVETTE SOMOANO-VILLA
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Gender | Female
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Dates
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Enumeration Date | 04/25/2014
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 2900 BRISTOL STREET SUITE C101
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City | COSTA MESA
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State | CA
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Zip | 92626-5981
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Country | US
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Telephone | 949-478-0657
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Fax | 714-486-3753
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Provider Business Mailing Address
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Address Line | 170 E 17TH ST STE 211
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City | COSTA MESA
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State | CA
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Zip | 92627-3701
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Country | US
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Telephone | 949-478-0657
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 20A10639
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License Number State | CA
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