Provider Demographics
NPI:1033618293
Name:SITH, SOMALY (FNP)
Entity Type:Individual
Prefix:
First Name:SOMALY
Middle Name:
Last Name:SITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11018 MOORPARK ST APT 303
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-3411
Mailing Address - Country:US
Mailing Address - Phone:404-213-0453
Mailing Address - Fax:
Practice Address - Street 1:4849 VAN NUYS BLVD # 202
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2110
Practice Address - Country:US
Practice Address - Phone:404-213-0453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013961363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily