Provider Demographics
NPI:1891760625
Name:SORIANO, JOSE
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:SORIANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16140 US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6508
Mailing Address - Country:US
Mailing Address - Phone:352-589-6424
Mailing Address - Fax:352-589-6496
Practice Address - Street 1:8-18 EUSTIS STREET
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726
Practice Address - Country:US
Practice Address - Phone:352-589-6424
Practice Address - Fax:352-589-6496
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90608208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics