Provider Demographics
NPI:1093952186
Name:SORIANO, EVELYN (RDH, RDA)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:SORIANO
Suffix:
Gender:F
Credentials:RDH, RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 E HUNTINGTON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3776
Mailing Address - Country:US
Mailing Address - Phone:626-447-5126
Mailing Address - Fax:626-447-0077
Practice Address - Street 1:440 E HUNTINGTON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3776
Practice Address - Country:US
Practice Address - Phone:626-447-5126
Practice Address - Fax:626-447-0077
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51629126800000X
CA24549124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant