Provider Demographics
NPI:1013275965
Name:SOMA SURGERY CENTER INC.
Entity type:Organization
Organization Name:SOMA SURGERY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAVAEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-673-0523
Mailing Address - Street 1:2160 CENTURY PARK E APT 602
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2214
Mailing Address - Country:US
Mailing Address - Phone:310-673-0523
Mailing Address - Fax:413-643-6360
Practice Address - Street 1:8929 WILSHIRE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1950
Practice Address - Country:US
Practice Address - Phone:310-855-8936
Practice Address - Fax:413-643-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00014995261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical