Provider Demographics
NPI:1275585507
Name:SORENSON, STEVEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:SORENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LLUHC RADIOLOGY
Mailing Address - Street 2:2068 ORANGE TREE LANE #215
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92354-1789
Mailing Address - Country:US
Mailing Address - Phone:909-558-4756
Mailing Address - Fax:949-263-1639
Practice Address - Street 1:LLUHC RADIOLOGY
Practice Address - Street 2:2068 ORANGE TREE LANE #215
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92354-1789
Practice Address - Country:US
Practice Address - Phone:909-558-4756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA652162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A652160OtherBLUE SHIELD OF CA
CA00A652160Medicaid
CAWA65216EMedicare PIN
CA00A652160OtherBLUE SHIELD OF CA
CAP00365965Medicare PIN
CAWA65216NMedicare PIN