Provider Demographics
NPI:1124418173
Name:SORIANO MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:SORIANO MEDICAL SERVICES INC
Other - Org Name:SORIANO MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DINO
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:SR
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:407-702-8095
Mailing Address - Street 1:171 CLOVER POINT CIR
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-7134
Mailing Address - Country:US
Mailing Address - Phone:407-702-8095
Mailing Address - Fax:
Practice Address - Street 1:171 CLOVER POINT CIR
Practice Address - Street 2:
Practice Address - City:GUYTON
Practice Address - State:GA
Practice Address - Zip Code:31312-7134
Practice Address - Country:US
Practice Address - Phone:407-702-8095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN19059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty