1396058137 NPI number — SOMAGEN HEALTHCARE INC

Table of content: (NPI 1396058137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396058137 NPI number — SOMAGEN HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOMAGEN HEALTHCARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AFC URGENT CARE OF SANTEE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396058137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10538 MISSION GORGE RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SANTEE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92071-3154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-456-0033
Provider Business Mailing Address Fax Number:
619-456-0095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10538 MISSION GORGE RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-3154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-456-0033
Provider Business Practice Location Address Fax Number:
619-456-0095
Provider Enumeration Date:
07/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DOUMAS
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
W
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
619-456-0033

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  20A5707 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QX0100X , with the licence number: 20A5707 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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