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General NPI Number Information
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NPI Number | 1811719438
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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 | 10/25/2024
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 6425 UNIVERSITY AVE
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City | SAN DIEGO
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State | CA
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Zip | 92115-5808
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Country | US
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Telephone | 760-983-2222
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Fax | 760-982-2410
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Provider Business Mailing Address
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Address Line | 6425 UNIVERSITY AVE
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City | SAN DIEGO
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State | CA
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Zip | 92115-5808
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Country | US
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Telephone | 760-983-2222
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Fax | 760-982-2410
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Authorized Official
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Title or Position | REGIONAL DIRECTOR
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Name | FRANCISCO MARC GONZALO
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Credential | MA
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Telephone | 760-305-7528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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Taxonomy #2
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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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