Provider Demographics
NPI:1801843073
Name:SORIANO, VIRGILIO J (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGILIO
Middle Name:J
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 1:1559 E AMAR RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1679
Mailing Address - Country:US
Mailing Address - Phone:626-810-1522
Mailing Address - Fax:626-810-2793
Practice Address - Street 1:1559 E AMAR RD
Practice Address - Street 2:SUITE F
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1679
Practice Address - Country:US
Practice Address - Phone:626-810-1522
Practice Address - Fax:626-810-2793
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA394380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A394380Medicaid
CAA39438Medicare ID - Type Unspecified
CA00A394380Medicaid