Healthcare Provider Details

I. General information

NPI: 1780461046
Provider Name (Legal Business Name): SOMA MEDICAL CENTER PA 11
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 ROYAL PALM BEACH BLVD STE 700
ROYAL PALM BEACH FL
33411-1699
US

IV. Provider business mailing address

1402 ROYAL PALM BEACH BLVD STE 700
ROYAL PALM BEACH FL
33411-1699
US

V. Phone/Fax

Practice location:
  • Phone: 561-650-5636
  • Fax: 561-720-2528
Mailing address:
  • Phone: 561-650-5636
  • Fax: 561-720-2528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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