Provider Demographics
NPI:1811719438
Name:SOAP MAT, LLC
Entity type:Organization
Organization Name:SOAP MAT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:GONZALO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:760-305-7528
Mailing Address - Street 1:6425 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5808
Mailing Address - Country:US
Mailing Address - Phone:760-983-2222
Mailing Address - Fax:760-982-2410
Practice Address - Street 1:6425 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-5808
Practice Address - Country:US
Practice Address - Phone:760-983-2222
Practice Address - Fax:760-982-2410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOAP MAT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-25
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone