MEDICARE: SOMA MEDICAL CENTER, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QP2300X	Primary Care Clinic/Center	ME0076971	FL
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1467499038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOMA MEDICAL CENTER, PA

Provider Business Mailing Address
First Line	:	3255 FOREST HILL BLVD STE 103
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33406-5854
Country	:	US
Telephone Number	:	561-964-4577
Fax Number	:	561-964-7772

Provider Business Practice Location Address
First Line	:	3255 FOREST HILL BLVD STE 103
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33406-5854
Country	:	US
Telephone Number	:	561-964-4577
Fax Number	:	561-964-7772

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. RAFAEL O NUNEZ
Credential	:	MD
Telephone Number	:	561-329-8917

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/12/2023

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Directions to “SOMA MEDICAL CENTER, PA ” Practice Location

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