Provider Demographics
NPI:1942210869
Name:SROUJI, SOL (CRNFA)
Entity Type:Individual
Prefix:
First Name:SOL
Middle Name:
Last Name:SROUJI
Suffix:
Gender:M
Credentials:CRNFA
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 4978
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95352-4978
Mailing Address - Country:US
Mailing Address - Phone:209-575-4575
Mailing Address - Fax:209-575-4598
Practice Address - Street 1:2801 COFFEE RD
Practice Address - Street 2:STE B1
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1756
Practice Address - Country:US
Practice Address - Phone:209-575-4575
Practice Address - Fax:209-575-4598
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA464887163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant