Provider Demographics
NPI:1780461046
Name:SOMA MEDICAL CENTER PA 11
Entity type:Organization
Organization Name:SOMA MEDICAL CENTER PA 11
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
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:561-964-4577
Mailing Address - Street 1:1402 ROYAL PALM BEACH BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1699
Mailing Address - Country:US
Mailing Address - Phone:561-650-5636
Mailing Address - Fax:561-720-2528
Practice Address - Street 1:1402 ROYAL PALM BEACH BLVD STE 700
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1699
Practice Address - Country:US
Practice Address - Phone:561-650-5636
Practice Address - Fax:561-720-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty