Provider Demographics
NPI:1376791798
Name:CO, MARIA ANA JEANELLEE SORIANO (MD)
Entity Type:Individual
Prefix:
First Name:MARIA ANA JEANELLEE
Middle Name:SORIANO
Last Name:CO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 N STONE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-0919
Mailing Address - Country:US
Mailing Address - Phone:386-822-9112
Mailing Address - Fax:
Practice Address - Street 1:1070 N STONE ST
Practice Address - Street 2:SUITE D
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0919
Practice Address - Country:US
Practice Address - Phone:386-822-9112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117946207RG0100X
MI4301091690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine