Provider Demographics
NPI:1477829802
Name:SOMMOVILLA, NILI BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:NILI
Middle Name:BETH
Last Name:SOMMOVILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1250 16TH ST STE 2304
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1249
Mailing Address - Country:US
Mailing Address - Phone:310-319-4698
Mailing Address - Fax:310-206-3260
Practice Address - Street 1:3800 RESERVOIR RD NW RM G-3041
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-3976
Practice Address - Fax:202-444-5104
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDC045067208M00000X
CAA141221208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program