Provider Demographics
NPI:1093878548
Name:SOFRONIO SORIANO PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SOFRONIO SORIANO PROFESSIONAL CORPORATION
Other - Org Name:SOFRONIO SORIANO MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HENDRICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-750-2837
Mailing Address - Street 1:PO BOX 30844
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89173-0844
Mailing Address - Country:US
Mailing Address - Phone:702-750-2837
Mailing Address - Fax:702-750-2847
Practice Address - Street 1:2610 S JONES BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5635
Practice Address - Country:US
Practice Address - Phone:702-750-2837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV39290Medicare ID - Type UnspecifiedMEDICARE GROUP