Provider Demographics
NPI:1760933709
Name:SOMA MEDICAL CENTER PA WELLINGTON
Entity Type:Organization
Organization Name:SOMA MEDICAL CENTER PA WELLINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALOMIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-275-1155
Mailing Address - Street 1:10131 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6156
Mailing Address - Country:US
Mailing Address - Phone:561-275-1155
Mailing Address - Fax:561-275-1156
Practice Address - Street 1:10131 FOREST HILL BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6156
Practice Address - Country:US
Practice Address - Phone:561-275-1155
Practice Address - Fax:561-275-1156
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOMA MEDICAL CENTER PA#4
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-14
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005584600Medicaid