Provider Demographics
NPI:1689634123
Name:SORIANO, SIMONETA SUMAGUE (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMONETA
Middle Name:SUMAGUE
Last Name:SORIANO
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 1:525 MARKS ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6654
Mailing Address - Country:US
Mailing Address - Phone:702-383-6210
Mailing Address - Fax:
Practice Address - Street 1:525 MARKS ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6654
Practice Address - Country:US
Practice Address - Phone:702-383-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508627Medicaid
NV100508627Medicaid
NV101975Medicare ID - Type Unspecified