Provider Demographics
NPI:1285027540
Name:SORO, JEFFERY SR
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:SORO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 E WASHINGTON AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-2553
Mailing Address - Country:US
Mailing Address - Phone:586-443-0435
Mailing Address - Fax:
Practice Address - Street 1:1519 E WASHINGTON AVE APT 6
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-2553
Practice Address - Country:US
Practice Address - Phone:586-443-0435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024592163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse