Provider Demographics
NPI:1558788620
Name:SOMAGEN HEALTHCARE INC
Entity type:Organization
Organization Name:SOMAGEN HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-362-9773
Mailing Address - Street 1:750 OTAY LAKES RD # 272
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6915
Mailing Address - Country:US
Mailing Address - Phone:855-362-9773
Mailing Address - Fax:
Practice Address - Street 1:5671 BALBOA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2705
Practice Address - Country:US
Practice Address - Phone:858-800-2880
Practice Address - Fax:619-569-2590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care