Provider Demographics
NPI:1467712752
Name:SORIANO, SHADETTE OLJOL (RN, BSN-BC)
Entity Type:Individual
Prefix:
First Name:SHADETTE
Middle Name:OLJOL
Last Name:SORIANO
Suffix:
Gender:F
Credentials:RN, BSN-BC
Other - Prefix:
Other - First Name:SHADETTE
Other - Middle Name:DALES
Other - Last Name:OLJOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11526 VIA SANTA BRISA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-4259
Mailing Address - Country:US
Mailing Address - Phone:858-414-8970
Mailing Address - Fax:
Practice Address - Street 1:7850 VISTA HILL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2717
Practice Address - Country:US
Practice Address - Phone:858-836-8360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA95022060163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program