Basic Information
Provider Information | |||||||||
NPI: | 1760933709 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SOMA MEDICAL CENTER PA WELLINGTON | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 10131 FOREST HILL BLVD | ||||||||
Address2: | SUITE 140 | ||||||||
City: | WELLINGTON | ||||||||
State: | FL | ||||||||
PostalCode: | 334146156 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5612751155 | ||||||||
FaxNumber: | 5612751156 | ||||||||
Practice Location | |||||||||
Address1: | 10131 FOREST HILL BLVD | ||||||||
Address2: | SUITE 140 | ||||||||
City: | WELLINGTON | ||||||||
State: | FL | ||||||||
PostalCode: | 334146156 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5612751155 | ||||||||
FaxNumber: | 5612751156 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/14/2016 | ||||||||
LastUpdateDate: | 04/02/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ALOMIA | ||||||||
AuthorizedOfficialFirstName: | PAOLA | ||||||||
AuthorizedOfficialMiddleName: | A | ||||||||
AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
AuthorizedOfficialTelephone: | 5612751155 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | SOMA MEDICAL CENTER PA#4 | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/02/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |   |
No ID Information.