Provider Demographics
NPI:1023187325
Name:OLIGANE TIBLE, CYNTHIA SORIANO (PA)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:SORIANO
Last Name:OLIGANE TIBLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:SORIANO
Other - Last Name:OLIGANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 18936
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118
Mailing Address - Country:US
Mailing Address - Phone:206-725-8043
Mailing Address - Fax:206-760-1359
Practice Address - Street 1:5023 S BARTON PLACE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118
Practice Address - Country:US
Practice Address - Phone:206-725-8043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001521363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8379026Medicaid