Healthcare Provider Details

I. General information

NPI: 1043667660
Provider Name (Legal Business Name): SOMAGEN HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16912 SAN FERNANDO MISSION BLVD
GRANADA HILLS CA
91344-4249
US

IV. Provider business mailing address

750 OTAY LAKES RD # 272
CHULA VISTA CA
91910-6915
US

V. Phone/Fax

Practice location:
  • Phone: 818-488-6160
  • Fax: 818-923-5386
Mailing address:
  • Phone: 855-362-9773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL LAREAUX
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 855-362-9773