1962400721 NPI number — SOMA HEALTH ASSOCIATES

Table of content: (NPI 1962400721)

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:
OPTION CARE
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:
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)