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General NPI Number Information
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NPI Number | 1619765989
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Entity Type | Organization
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Legal Business Name | SOMA MEDICAL CENTER, P.A.
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 1170 SW BAYSHORE BLVD STE 200
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-2408
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Country | US
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Telephone | 564-964-4577
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Fax |
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Provider Business Mailing Address
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Address Line | 3129 S CONGRESS AVE
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City | PALM SPRINGS
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State | FL
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Zip | 33461-2551
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Country | US
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Telephone | 564-964-4577
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Fax | 561-964-4575
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Authorized Official
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Title or Position | MEDICAL DIRECTOR, PRESIDENT
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Name | RAFAEL O NUNEZ
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Credential | MD
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Telephone | 561-964-4577
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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 |
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License Number State |
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