Basic Information
| Provider Information | |||||||||
| NPI: | 1922565241 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOMOS CARE MANAGEMENT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1434 WILLIAMSBRIDGE RD FL 2 | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186180401 | ||||||||
| FaxNumber: | 3474791303 | ||||||||
| Practice Location | |||||||||
| Address1: | 1371 SEABURY AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104613629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186180401 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2019 | ||||||||
| LastUpdateDate: | 10/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | GONZALEZ | ||||||||
| AuthorizedOfficialFirstName: | ROSEMARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7186180401 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.