Provider Demographics
NPI:1639873144
Name:SOMOS MEDICAL PC
Entity Type:Organization
Organization Name:SOMOS MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:CASTILLO TALLAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:551-502-0013
Mailing Address - Street 1:2910 EXTERIOR ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-7104
Mailing Address - Country:US
Mailing Address - Phone:833-766-6769
Mailing Address - Fax:347-825-6928
Practice Address - Street 1:2910 EXTERIOR ST FL 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-7104
Practice Address - Country:US
Practice Address - Phone:833-766-3622
Practice Address - Fax:347-825-6928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty