Healthcare Provider Details

I. General information

NPI: 1942770912
Provider Name (Legal Business Name): SOMA MEDICAL CENTER, P. A #4
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10125 W COLONIAL DR STE 204
OCOEE FL
34761-4200
US

IV. Provider business mailing address

10125 W COLONIAL DR STE 204
OCOEE FL
34761-4200
US

V. Phone/Fax

Practice location:
  • Phone: 561-281-4707
  • Fax: 561-275-7151
Mailing address:
  • Phone: 561-275-1155
  • Fax: 561-275-7151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PAOLA A ALOMIA
Title or Position: ASSISTANCE PRACTICE ADM
Credential:
Phone: 561-275-1155