Healthcare Provider Details

I. General information

NPI: 1811719438
Provider Name (Legal Business Name): SOAP MAT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6425 UNIVERSITY AVE
SAN DIEGO CA
92115-5808
US

IV. Provider business mailing address

6425 UNIVERSITY AVE
SAN DIEGO CA
92115-5808
US

V. Phone/Fax

Practice location:
  • Phone: 760-983-2222
  • Fax: 760-982-2410
Mailing address:
  • Phone: 760-983-2222
  • Fax: 760-982-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: FRANCISCO MARC GONZALO
Title or Position: REGIONAL DIRECTOR
Credential: MA
Phone: 760-305-7528