Provider Demographics
NPI:1962400721
Name:SOMA HEALTH ASSOCIATES
Entity type:Organization
Organization Name:SOMA HEALTH ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:707-766-7878
Mailing Address - Street 1:35 MARIA DR
Mailing Address - Street 2:SUITE 860
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-3548
Mailing Address - Country:US
Mailing Address - Phone:707-766-7878
Mailing Address - Fax:707-766-7055
Practice Address - Street 1:35 MARIA DR
Practice Address - Street 2:SUITE 860
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-3548
Practice Address - Country:US
Practice Address - Phone:707-766-7878
Practice Address - Fax:707-766-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 39388183500000X
CARPH 42925183500000X
CAPHY37491333600000X
CA169110364SH0200X
CA315544364SH0200X
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Not Answered333600000XSuppliersPharmacyGroup - Single Specialty
Not Answered364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Single Specialty
Not Answered251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0316750001Medicare ID - Type Unspecified
CAPHA379410Medicare ID - Type Unspecified