Provider Demographics
NPI:1689754392
Name:SORIANO, CARLOS BIENVENIDO (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:BIENVENIDO
Last Name:SORIANO
Suffix:
Gender:M
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:PO BOX 1720
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253
Mailing Address - Country:US
Mailing Address - Phone:770-957-3393
Mailing Address - Fax:770-957-4902
Practice Address - Street 1:350 HUNTINGTON PLACE COURT
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253
Practice Address - Country:US
Practice Address - Phone:770-957-3393
Practice Address - Fax:770-957-4902
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048575208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00856655AMedicaid