Provider Demographics
NPI:1346224383
Name:SOMOSO, MARIFE C (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARIFE
Middle Name:C
Last Name:SOMOSO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:MARIFE
Other - Middle Name:CAMAGAY
Other - Last Name:SOMOSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:956-630-5522
Mailing Address - Fax:956-682-7730
Practice Address - Street 1:500 E RIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1508
Practice Address - Country:US
Practice Address - Phone:956-630-5522
Practice Address - Fax:956-682-7730
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX589985363L00000X
TXAP111774363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3162414-01Medicaid
TX8D7196Medicare PIN
TX275699YN0EMedicare PIN