Provider Demographics
NPI:1508026725
Name:MICHAEL S SOMERO MD - A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL S SOMERO MD - A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:SOMERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-322-8888
Mailing Address - Street 1:1330 N INDIAN CANYON DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4880
Mailing Address - Country:US
Mailing Address - Phone:760-322-8888
Mailing Address - Fax:760-322-7710
Practice Address - Street 1:1330 N INDIAN CANYON DR
Practice Address - Street 2:SUITE H
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4880
Practice Address - Country:US
Practice Address - Phone:760-322-8888
Practice Address - Fax:760-322-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77068207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA440002198OtherRAILROAD MEDICARE
CA1508026725Medicaid
CA1508026725Medicaid