Provider Demographics
NPI:1073640603
Name:SOMEILLAN, JOSEPH J (BC-HIS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:SOMEILLAN
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10966 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2308
Mailing Address - Country:US
Mailing Address - Phone:305-519-6699
Mailing Address - Fax:305-225-5481
Practice Address - Street 1:10966 SW 28TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2308
Practice Address - Country:US
Practice Address - Phone:305-519-6699
Practice Address - Fax:305-225-5481
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2596174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist