| Soma Medical Group | |
|
1959 Kingsdale Ave Redondo Beach CA 90278-3417 | |
| (310) 214-1000 | |
| (310) 214-8540 |
| Full Name | Soma Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 1959 Kingsdale Ave, Redondo Beach, California |
| Authorized Official Name and Position | Sohail Davoudian (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3102141000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Soma Medical Group Po Box 5090 Redondo Beach CA 90278-9290 Ph: (310) 214-1000 | Soma Medical Group 1959 Kingsdale Ave Redondo Beach CA 90278-3417 Ph: (310) 214-1000 |
| NPI Number | 1063434900 |
|---|---|
| Provider Enumeration Date | 07/23/2006 |
| Last Update Date | 12/04/2008 |
| Medicare PECOS PAC ID | 9436190964 |
|---|---|
| Medicare Enrollment ID | O20050516000386 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063434900 | NPI | - | NPPES |
| GR0059090 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A44878 (California) | Primary |
| Provider Name | Sohail Davoudian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255462248 PECOS PAC ID: 7012067069 Enrollment ID: I20090717000020 |
| Provider Name | Josephine R Cabugnason |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336585819 PECOS PAC ID: 5193965606 Enrollment ID: I20130705000217 |
| Provider Name | Annalissa L Flores |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740626100 PECOS PAC ID: 5890936363 Enrollment ID: I20130725000385 |
| Provider Name | Roggielyz Padilla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124566724 PECOS PAC ID: 3678848264 Enrollment ID: I20171006002983 |
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