Provider Demographics
NPI:1194050039
Name:SOMODEAN, LUCIA
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:SOMODEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20493 N 91ST DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-5271
Mailing Address - Country:US
Mailing Address - Phone:602-716-1189
Mailing Address - Fax:623-939-1339
Practice Address - Street 1:20493 N 91ST DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-5271
Practice Address - Country:US
Practice Address - Phone:602-716-1189
Practice Address - Fax:623-939-1339
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL5800H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility