Provider Demographics
NPI:1356068639
Name:SOMERA, EDWARD ANTHONY
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ANTHONY
Last Name:SOMERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 HOUGHTAILING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1945
Mailing Address - Country:US
Mailing Address - Phone:808-551-0738
Mailing Address - Fax:
Practice Address - Street 1:1240 GULICK AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4116
Practice Address - Country:US
Practice Address - Phone:808-832-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician