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General NPI Number Information
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NPI Number | 1295145704
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Entity Type | Organization
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Legal Business Name | SOMA MEDICAL CENTER PA 6
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 04/18/2022
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Provider Practice Location Address
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Address Line | 3580 LAKE WORTH RD
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City | PALM SPRINGS
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State | FL
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Zip | 33461-4029
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Country | US
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Telephone | 561-275-1155
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Fax | 561-275-1156
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Provider Business Mailing Address
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Address Line | 3580 LAKE WORTH RD
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City | PALM SPRINGS
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State | FL
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Zip | 33461-4029
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Country | US
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Telephone | 561-275-1155
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Fax | 561-275-1156
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | RAFAEL O NUNEZ
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Credential | MD
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Telephone | 561-275-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME0076971
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License Number State | FL
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