Provider Demographics
NPI:1598724106
Name:SOMOZA-BLANCO, BEATRIZ (MD)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:SOMOZA-BLANCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:BEATRIZ
Other - Middle Name:
Other - Last Name:SOMOZA-MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2977 COUNTY ROAD CX
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901
Practice Address - Country:US
Practice Address - Phone:608-742-3004
Practice Address - Fax:608-742-2399
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine