Basic Information
| Provider Information | |||||||||
| NPI: | 1740690254 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOMA MEDICAL CENTER PA 7 | ||||||||
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| OtherOrganizationName: | SOMA MEDICAL CENTER PA 7 | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3580 LAKE WORTH RD | ||||||||
| Address2: | |||||||||
| City: | PALM SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334614029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614255085 | ||||||||
| FaxNumber: | 5614295167 | ||||||||
| Practice Location | |||||||||
| Address1: | 3580 LAKE WORTH ROAD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612751155 | ||||||||
| FaxNumber: | 5612751156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2014 | ||||||||
| LastUpdateDate: | 08/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | FLORES | ||||||||
| AuthorizedOfficialFirstName: | ZULMA | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5614255085 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME76971 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.