Provider Demographics
NPI:1609449362
Name:SOMA MEDICAL CENTER .PA #6
Entity Type:Organization
Organization Name:SOMA MEDICAL CENTER .PA #6
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-530-4112
Mailing Address - Street 1:3580 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4775 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-7941
Practice Address - Country:US
Practice Address - Phone:561-328-8631
Practice Address - Fax:561-557-4910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOMA MEDICAL CENTER #6
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-21
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01434400Medicaid