Basic Information
| Provider Information | |||||||||
| NPI: | 1720191471 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOMOHANO | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PMB 456 | ||||||||
| Address2: | 89 DE DIEGO AVENUE, SUITE 105 | ||||||||
| City: | RIO PIEDRAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009276346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877260210 | ||||||||
| FaxNumber: | 7877285136 | ||||||||
| Practice Location | |||||||||
| Address1: | CALLE SAN JORGE # 252 SAN JORGE MEDICAL OFFICE | ||||||||
| Address2: | SUITE 406 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877260210 | ||||||||
| FaxNumber: | 7877285136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0203X | 8534 | PR | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8-1931 | 01 | PR | SSS | OTHER |