Provider Demographics
NPI:1679749998
Name:GUILLERMO SOMODEVILLA MD PA
Entity Type:Organization
Organization Name:GUILLERMO SOMODEVILLA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMODEVILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-269-0385
Mailing Address - Street 1:7805 CORAL WAY
Mailing Address - Street 2:#126
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6539
Mailing Address - Country:US
Mailing Address - Phone:305-269-0385
Mailing Address - Fax:305-269-0386
Practice Address - Street 1:7805 CORAL WAY
Practice Address - Street 2:#126
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6539
Practice Address - Country:US
Practice Address - Phone:305-269-0385
Practice Address - Fax:305-269-0386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049294261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care