| Entity Name: | SOMA MEDICAL CENTER, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 Jul 2000 (25 years ago) |
| Document Number: | P00000065696 |
| FEI/EIN Number | 651023762 |
| Address: | 3255 FOREST HILL BLVD, SUITE 103, WEST PALM BEACH, FL, 33406, US |
| Mail Address: | 3255 FOREST HILL BLVD, SUITE 103, WEST PALM BEACH, FL, 33406, US |
| ZIP code: | 33406 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730921412 | 2024-06-12 | 2024-06-12 | 3145 S CONGRESS AVE STE A, PALM SPRINGS, FL, 334612553, US | 3145 S CONGRESS AVE STE A, PALM SPRINGS, FL, 334612553, US | |||||||||||||||
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| Phone | +1 561-559-2371 |
| Fax | 5615304540 |
Authorized person
| Name | CAROLINA ZAMORANO |
| Role | CREDENTIALING ADMINISTRATOR |
| Phone | 3212026231 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| NUNEZ RAFAEL O | Agent | 13628 QUARTER HORSE TRAIL, WELLINGTON, FL, 33414 |
| Name | Role | Address |
|---|---|---|
| NUNEZ RAFAEL O | President | 3255 FOREST HILL BLVD, WEST PALM BEACH, FL, 33406 |
| Name | Role | Address |
|---|---|---|
| FLOREZ-NUNEZ JACQUELINE | Chief Executive Officer | 3255 FOREST HILL BLVD, WEST PALM BEACH, FL, 33406 |
| Name | Role | Address |
|---|---|---|
| FLOREZ ANDRES | Vice President | 3255 FOREST HILL BLVD STE 103, WEST PALM BEACH, FL, 33406 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000068166 | SOMA WELLHEALTH | ACTIVE | 2021-05-19 | 2026-12-31 | No data | 3255 FOREST HILL BLVD, SUITE 103, WEST PALM BEACH, FL, 33406 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2012-10-05 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| AMENDMENT | 2005-05-23 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
