Provider Demographics
NPI:1093146292
Name:SORAJO, MAMI (RD)
Entity Type:Individual
Prefix:
First Name:MAMI
Middle Name:
Last Name:SORAJO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2170
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-0480
Mailing Address - Country:US
Mailing Address - Phone:253-840-2313
Mailing Address - Fax:
Practice Address - Street 1:2904 4TH AVE NE
Practice Address - Street 2:STE 300
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-7053
Practice Address - Country:US
Practice Address - Phone:253-840-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 00001474133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered