Healthcare Provider Details

I. General information

NPI: 1467499038
Provider Name (Legal Business Name): SOMA MEDICAL CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 FOREST HILL BLVD STE 103
PALM SPRINGS FL
33406-5854
US

IV. Provider business mailing address

3255 FOREST HILL BLVD STE 103
PALM SPRINGS FL
33406-5854
US

V. Phone/Fax

Practice location:
  • Phone: 561-964-4577
  • Fax: 561-964-7772
Mailing address:
  • Phone: 561-964-4577
  • Fax: 561-964-7772

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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME0076971
License Number StateFL

VIII. Authorized Official

Name: DR. RAFAEL O NUNEZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 561-329-8917