| Entity Name: | SOMA MEDICAL CENTER PA 12 |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 20 Sep 2023 (a year ago) |
| Document Number: | P23000067952 |
| FEI/EIN Number | 93-3521992 |
| Address: | 4775 N CONGRESS AVE, BOYNTON BEACH, FL 33426 |
| Mail Address: | 3255 Forest Hill Blvd, Suite 103, WEST PALM BEACH, FL 33406 |
| ZIP code: | 33426 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558149385 | 2023-09-21 | 2023-09-21 | 4775 N CONGRESS AVE, BOYNTON BEACH, FL, 334267941, US | 4775 N CONGRESS AVE, BOYNTON BEACH, FL, 334267941, US | |||||||||||||||
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| Phone | +1 561-328-8631 |
| Fax | 5613288632 |
Authorized person
| Name | DR. RAFAEL O NUNEZ |
| Role | PRESIDENT, MEDICAL DIRECTOR |
| Phone | 5619644577 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| FLOREZ-NUNEZ, JACQUELINE | Agent | 13628 QUARTER HORSE TRAIL, WELLINGTON, FL 33414 |
| Name | Role | Address |
|---|---|---|
| FLOREZ-NUNEZ, JACQUELINE | President | 13628 QUARTER HORSE TRAIL, WELLINGTON, FL 33414 |
| Name | Role | Address |
|---|---|---|
| NUNEZ, RAFAEL | Vice President | 13628 QUARTER HORSE TRAIL, WELLINGTON, FL 33414 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-12-11 | 4775 N CONGRESS AVE, BOYNTON BEACH, FL 33426 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-18 |
| Domestic Profit | 2023-09-20 |
Date of last update: 08 Jan 2025
Sources: Florida Department of State
