Provider Demographics
NPI:1962363960
Name:SOMA, LLC
Entity type:Organization
Organization Name:SOMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COSMETIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONDOLEON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-320-0916
Mailing Address - Street 1:12107 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8146
Mailing Address - Country:US
Mailing Address - Phone:515-395-7661
Mailing Address - Fax:515-395-7663
Practice Address - Street 1:12107 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8146
Practice Address - Country:US
Practice Address - Phone:515-395-7661
Practice Address - Fax:515-395-7663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty