Healthcare Provider Details

I. General information

NPI: 1558788620
Provider Name (Legal Business Name): SOMAGEN HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 BALBOA AVE
SAN DIEGO CA
92111-2705
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 858-800-2880
  • Fax: 619-569-2590
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: DANIEL LAREAUX
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 855-362-9773