Provider Demographics
NPI:1164641650
Name:SORIANO, DEOMEL M (PMHNP-BC, RN, MSN)
Entity Type:Individual
Prefix:
First Name:DEOMEL
Middle Name:M
Last Name:SORIANO
Suffix:
Gender:M
Credentials:PMHNP-BC, RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 W MADISON AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3454
Mailing Address - Country:US
Mailing Address - Phone:619-334-7542
Mailing Address - Fax:619-938-2568
Practice Address - Street 1:225 W MADISON AVE STE 2
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3454
Practice Address - Country:US
Practice Address - Phone:619-334-7542
Practice Address - Fax:619-938-2568
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006790363LP0808X
CA786457163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1164641650Medicaid