Provider Demographics
NPI:1619765989
Name:SOMA MEDICAL CENTER, P.A.
Entity type:Organization
Organization Name:SOMA MEDICAL CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR, PRESIDENT
Authorized Official - Prefix:
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 1:3129 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2551
Mailing Address - Country:US
Mailing Address - Phone:564-964-4577
Mailing Address - Fax:561-964-4575
Practice Address - Street 1:1170 SW BAYSHORE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-2408
Practice Address - Country:US
Practice Address - Phone:564-964-4577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOMA MEDICAL CENTER, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care