1437860236 NPI number — SOMA PSYCH FAMILY THERAPY, INC.

Table of content: (NPI 1437860236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437860236 NPI number — SOMA PSYCH FAMILY THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOMA PSYCH FAMILY THERAPY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437860236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 PONIU CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAILUKU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96793-2906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-459-9790
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021 SPERRY AVE STE 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93003-7446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-459-9790
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2022

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
MARTENA
Authorized Official Middle Name:
RACHEL
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER (CEO)
Authorized Official Telephone Number:
760-459-9790

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com