| Entity Name: | SOMA MEDICAL CENTER PA #9 |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 15 Jan 2020 (5 years ago) |
| Document Number: | P20000006427 |
| FEI/EIN Number | 84-4485014 |
| Address: | 3255 FOREST HILL BLVD STE 103, WEST PALM BEACH, FL 33406 |
| Mail Address: | 3255 FOREST HILL BLVD STE 103, WEST PALM BEACH, FL 33406 |
| ZIP code: | 33406 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982379442 | 2021-08-16 | 2023-06-30 | 3325 FOREST HILL BLVD STE B, WEST PALM BEACH, FL, 334065812, US | 3325 FOREST HILL BLVD STE B, PALM SPRINGS, FL, 334065812, US | |||||||||||||||||||||||
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| Phone | +1 561-227-2772 |
| Fax | 5612090154 |
| Phone | +1 561-964-4577 |
Authorized person
| Name | RAFAEL NUNEZ |
| Role | OWNER |
| Phone | 5619644577 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 115115000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FLOREZ-NUNEZ, JACQUELINE | Agent | 3255 FOREST HILL BLVD STE 103, WEST PALM BEACH, FL 33406 |
| Name | Role | Address |
|---|---|---|
| NUNEZ, RAFAEL O | President | 3255 FOREST HILL BLVD STE 103, WEST PALM BEACH, FL 33406 |
| Name | Role | Address |
|---|---|---|
| FLOREZ-NUNEZ, JACQUELINE | Chief Executive Officer | 3255 FOREST HILL BLVD STE 103, WEST PALM BEACH, FL 33406 |
| Name | Role | Address |
|---|---|---|
| FLOREZ-NUNEZ, JACQUELINE | Secretary | 3255 FOREST HILL BLVD STE 103, WEST PALM BEACH, FL 33406 |
| Name | Role | Address |
|---|---|---|
| NUNEZ, CATALINA | Executive Secretary | 3255 FOREST HILL BLVD STE 103, WEST PALM BEACH, FL 33406 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-18 |
| ANNUAL REPORT | 2023-01-22 |
| ANNUAL REPORT | 2022-01-13 |
| ANNUAL REPORT | 2021-02-02 |
| Domestic Profit | 2020-01-15 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
