Healthcare Provider Details

I. General information

NPI: 1063754588
Provider Name (Legal Business Name): SOMA MEDICAL CENTER PA #5
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 09/26/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S DIXIE HWY
LAKE WORTH FL
33460-4400
US

IV. Provider business mailing address

330 S DIXIE HWY
LAKE WORTH FL
33460-4400
US

V. Phone/Fax

Practice location:
  • Phone: 561-227-3993
  • Fax: 561-855-4308
Mailing address:
  • Phone: 561-227-3993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAFAEL O NUNEZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 561-964-4577