Healthcare Provider Details

I. General information

NPI: 1093903205
Provider Name (Legal Business Name): SOMA ORTHOPEDICS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 VALENCIA ST SUITE 703
SAN FRANCISCO CA
94110-4423
US

IV. Provider business mailing address

PO BOX 1230
SUISUN CITY CA
94585-1230
US

V. Phone/Fax

Practice location:
  • Phone: 415-642-0707
  • Fax: 415-550-1566
Mailing address:
  • Phone: 415-642-0707
  • Fax: 415-550-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA79161
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA90204
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG65707
License Number StateCA

VIII. Authorized Official

Name: DAVE ATKIN
Title or Position: PRESIDENT
Credential: MD
Phone: 415-550-1474