Basic Information
| Provider Information | |||||||||
| NPI: | 1265069694 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOMA MEDICAL CENTER, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3255 FOREST HILL BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619644577 | ||||||||
| FaxNumber: | 5612747134 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 SOUTH DIXIE HWAY | ||||||||
| Address2: | |||||||||
| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612273993 | ||||||||
| FaxNumber: | 5618554308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2020 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| AuthorizedOfficialLastName: | ALOMIA | ||||||||
| AuthorizedOfficialFirstName: | PAOLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING/CREDENTIALING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5612814707 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000853901 | 05 | FL | MEDICAID |