Provider Demographics
NPI:1942248935
Name:SORIANO, MIRIAM (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
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 1:420 WILLIAMSON WAY
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1251
Mailing Address - Country:US
Mailing Address - Phone:541-488-3616
Mailing Address - Fax:541-512-1689
Practice Address - Street 1:420 WILLIAMSON WAY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1251
Practice Address - Country:US
Practice Address - Phone:541-488-3616
Practice Address - Fax:541-512-1689
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORE28575Medicare UPIN
OR104012Medicare ID - Type Unspecified