MEDICARE: SOMA MEDICAL CENTER, PA #4

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1366397192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOMA MEDICAL CENTER, PA #4

Provider Business Mailing Address
First Line	:	2504 ACORN ST STE B
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4746
Country	:	US
Telephone Number	:	772-837-7800
Fax Number	:	772-837-7801

Provider Business Practice Location Address
First Line	:	2504 ACORN ST STE B
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4746
Country	:	US
Telephone Number	:	772-837-7800
Fax Number	:	772-837-7801

Authorized Official
Title or Position	:	PRACTICE ADM
Name	:	PAOLA A ALOMIA
Credential	:
Telephone Number	:	561-275-1155

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	02/26/2026

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