Provider Demographics
NPI:1700917655
Name:SOMOHANO, JOSE V (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:V
Last Name:SOMOHANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 193467
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3467
Mailing Address - Country:US
Mailing Address - Phone:787-756-0100
Mailing Address - Fax:787-756-0103
Practice Address - Street 1:652 AVE MUNOZ RIVERA STE 2065
Practice Address - Street 2:AVE MUNOS RIVERA 652
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4079
Practice Address - Country:US
Practice Address - Phone:787-756-0100
Practice Address - Fax:787-756-0103
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR12040207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI27059Medicare UPIN