Provider Demographics
NPI:1134486996
Name:SORIANO, ROGELIO LOPEZ (RN CRNI)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:LOPEZ
Last Name:SORIANO
Suffix:
Gender:M
Credentials:RN CRNI
Other - Prefix:
Other - First Name:ROGER
Other - Middle Name:LOPEZ
Other - Last Name:SORIANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17316 MAYALL ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1527
Mailing Address - Country:US
Mailing Address - Phone:919-687-8348
Mailing Address - Fax:
Practice Address - Street 1:315 VIRGINIA CT
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3972
Practice Address - Country:US
Practice Address - Phone:734-288-8776
Practice Address - Fax:734-667-5566
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704271198163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy