| Entity Name: | SOMA MEDICAL CENTER PA #6 |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 14 Feb 2014 (11 years ago) |
| Document Number: | P14000014455 |
| FEI/EIN Number | 46-4838927 |
| Mail Address: | 3255 FOREST HILL BLVD, STE 103, WEST PALM BEACH, FL, 33406, US |
| Address: | 3580 LAKE WORTH RD, LAKE WORTH, FL, 33461-4029, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609449362 | 2021-07-21 | 2022-01-18 | 3580 LAKE WORTH RD, LAKE WORTH, FL, 33461, US | 4775 N CONGRESS AVE, BOYNTON BEACH, FL, 334267941, US | |||||||||||||||||||||
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| Phone | +1 561-328-8631 |
| Fax | 5615574910 |
Authorized person
| Name | RAFAEL O NUNEZ |
| Role | MEDICAL DIRECTOR/OWNER |
| Phone | 5615304112 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 01434400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FLOREZ-NUNEZ JACQUELINE | Agent | 13628 QUARTER HORSE TRAIL, WELLINGTON, FL, 33414 |
| Name | Role | Address |
|---|---|---|
| NUNEZ RAFAEL | President | 13628 QUARTER HORSE TRAIL, WELLINGTON, FL, 33414 |
| Name | Role | Address |
|---|---|---|
| FLOREZ-NUNEZ JACQUELINE | Chief Executive Officer | 13628 QUARTER HORSE TRAIL, WELLINGTON, FL, 33414 |
| Name | Role | Address |
|---|---|---|
| NUNEZ CATALINA | Chief Financial Officer | 3255 FOREST HILL BLVD STE 103, WEST PALM BEACH, FL, 33406 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2025-01-21 | 3255 FOREST HILL BLVD, STE 103, WEST PALM BEACH, FL 33406 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-22 | 3580 LAKE WORTH RD, LAKE WORTH, FL 33461-4029 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-21 |
| ANNUAL REPORT | 2024-02-22 |
| ANNUAL REPORT | 2023-01-24 |
| ANNUAL REPORT | 2022-01-13 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-03-01 |
| ANNUAL REPORT | 2018-01-29 |
| ANNUAL REPORT | 2017-04-18 |
| ANNUAL REPORT | 2016-02-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
