Provider Demographics
NPI:1659241495
Name:SORRENTO COMPOUNDING LLC
Entity type:Organization
Organization Name:SORRENTO COMPOUNDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAGWANT
Authorized Official - Middle Name:
Authorized Official - Last Name:RAI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:858-531-3151
Mailing Address - Street 1:4040 SORRENTO VALLEY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1415
Mailing Address - Country:US
Mailing Address - Phone:619-736-7770
Mailing Address - Fax:
Practice Address - Street 1:4040 SORRENTO VALLEY BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1415
Practice Address - Country:US
Practice Address - Phone:619-736-7770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-07
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy