Provider Demographics
NPI:1467274571
Name:SOMOS PSYCHOLOGICAL INC
Entity type:Organization
Organization Name:SOMOS PSYCHOLOGICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YAN
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:SOMOZA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:760-464-8442
Mailing Address - Street 1:1900 E TAHQUITZ CANYON WAY STE A2
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7060
Mailing Address - Country:US
Mailing Address - Phone:760-320-0214
Mailing Address - Fax:
Practice Address - Street 1:1900 E TAHQUITZ CANYON WAY STE A2
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7060
Practice Address - Country:US
Practice Address - Phone:760-320-0214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty