Provider Demographics
NPI:1043407083
Name:SOMERA, DIWATA V (APRN-BC)
Entity Type:Individual
Prefix:
First Name:DIWATA
Middle Name:V
Last Name:SOMERA
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:DIWATA
Other - Middle Name:P
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1308 TIMBER OAKS RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1548
Mailing Address - Country:US
Mailing Address - Phone:732-754-1868
Mailing Address - Fax:732-846-7001
Practice Address - Street 1:1543 ROUTE 27
Practice Address - Street 2:SUITE 14
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-846-7000
Practice Address - Fax:734-846-7001
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00127000207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty