Healthcare Provider Details

I. General information

NPI: 1013275965
Provider Name (Legal Business Name): SOMA SURGERY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 WILSHIRE BLVD STE 102
BEVERLY HILLS CA
90211-1950
US

IV. Provider business mailing address

2160 CENTURY PARK E APT 602
LOS ANGELES CA
90067-2214
US

V. Phone/Fax

Practice location:
  • Phone: 310-855-8936
  • Fax: 413-643-6360
Mailing address:
  • Phone: 310-673-0523
  • Fax: 413-643-6360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number00014995
License Number StateCA

VIII. Authorized Official

Name: DR. SEAN S RAVAEI
Title or Position: OWNER
Credential:
Phone: 310-673-0523