1962400721 NPI number — SOMA HEALTH ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962400721 NPI number — SOMA HEALTH ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOMA HEALTH ASSOCIATES
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:
Provider Other Organization Name Type Code:
6
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:
1962400721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 MARIA DR
Provider Second Line Business Mailing Address:
SUITE 860
Provider Business Mailing Address City Name:
PETALUMA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94954-3548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-766-7878
Provider Business Mailing Address Fax Number:
707-766-7055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 MARIA DR
Provider Second Line Business Practice Location Address:
SUITE 860
Provider Business Practice Location Address City Name:
PETALUMA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94954-3548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-766-7878
Provider Business Practice Location Address Fax Number:
707-766-7055
Provider Enumeration Date:
07/14/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
707-766-7878

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH 39388 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 183500000X , with the licence number: RPH 42925 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 333600000X , with the licence number: PHY37491 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 364SH0200X , with the licence number: 169110 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 364SH0200X , with the licence number: 315544 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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