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General NPI Number Information
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NPI Number | 1477867760
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Entity Type | Organization
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Legal Business Name | SOAP MAT, LLC
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Dates
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Enumeration Date | 07/29/2010
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 1939 W VISTA WAY
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City | VISTA
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State | CA
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Zip | 92083-6019
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Country | US
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Telephone | 760-305-7528
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Fax | 760-509-4410
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Provider Business Mailing Address
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Address Line | 1939 W VISTA WAY
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City | VISTA
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State | CA
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Zip | 92083-6019
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Country | US
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Telephone | 760-305-7528
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Fax | 760-509-4410
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Authorized Official
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Title or Position | CEO
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Name | DR. LAURA ELLEN ROSSI
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Credential | PHD.
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Telephone | 760-274-3158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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