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NPI Code Detail

MEDICARE: VANNA SOM MA.

MEDICARE: VANNA SOM MA.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1104133941
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANNA SOM MA.
Provider Business Mailing Address
First Line : 2275 ARLINGTON DR
Second Line :
City : SAN LEANDRO
State : CA
Zip : 94578-1132
Country : US
Telephone Number : 510-317-1444
Fax Number :
Provider Business Practice Location Address
First Line : 1160 N DUTTON AVE STE 105
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-4652
Country : US
Telephone Number : 707-317-1444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2010
Last Update Date : 08/31/2010

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Directions to “ VANNA SOM MA.” Practice Location

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