Provider Demographics
NPI:1972923134
Name:SOMOANO-VILLA, YVETTE
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:SOMOANO-VILLA
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 1:170 E 17TH ST STE 211
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3701
Mailing Address - Country:US
Mailing Address - Phone:949-478-0657
Mailing Address - Fax:
Practice Address - Street 1:2900 BRISTOL STREET
Practice Address - Street 2:SUITE C101
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5981
Practice Address - Country:US
Practice Address - Phone:949-478-0657
Practice Address - Fax:714-486-3753
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10639204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM