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NPI Code Detail

MEDICARE: SOAP MAT, LLC

MEDICARE: SOAP MAT, LLC
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1477867760
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOAP MAT, LLC
Provider Business Mailing Address
First Line : 1939 W VISTA WAY
Second Line :
City : VISTA
State : CA
Zip : 92083-6019
Country : US
Telephone Number : 760-305-7528
Fax Number : 760-509-4410
Provider Business Practice Location Address
First Line : 1939 W VISTA WAY
Second Line :
City : VISTA
State : CA
Zip : 92083-6019
Country : US
Telephone Number : 760-305-7528
Fax Number : 760-509-4410
Authorized Official
Title or Position : CEO
Name : DR. LAURA ELLEN ROSSI
Credential : PHD.
Telephone Number : 760-274-3158
Provider Enumeration Date : 07/29/2010
Last Update Date : 11/20/2024

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Directions to “SOAP MAT, LLC ” Practice Location

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