Provider Demographics
NPI:1649933433
Name:SOOMA LLC
Entity type:Organization
Organization Name:SOOMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNYCK
Authorized Official - Middle Name:
Authorized Official - Last Name:BESSO
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:202-738-4726
Mailing Address - Street 1:909 G ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2819
Mailing Address - Country:US
Mailing Address - Phone:202-738-4726
Mailing Address - Fax:800-238-9511
Practice Address - Street 1:909 G ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2819
Practice Address - Country:US
Practice Address - Phone:202-738-4726
Practice Address - Fax:800-238-9511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty