Provider Demographics
NPI:1366637803
Name:SOMOZA, YAN MANUEL JR (PHD)
Entity type:Individual
Prefix:DR
First Name:YAN
Middle Name:MANUEL
Last Name:SOMOZA
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 EAST TAHQUITZ CANYON WAY
Mailing Address - Street 2:SUITE A2
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262
Mailing Address - Country:US
Mailing Address - Phone:760-320-0214
Mailing Address - Fax:949-739-0217
Practice Address - Street 1:1900 EAST TAHQUITZ CANYON WAY
Practice Address - Street 2:SUITE A2
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-320-0214
Practice Address - Fax:949-739-0217
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 25253103TC0700X
PSY25253103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical