Provider Demographics
NPI:1023079852
Name:SORIA, CAROLINA M (DO)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:M
Last Name:SORIA
Suffix:
Gender:F
Credentials:DO
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 764
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0764
Mailing Address - Country:US
Mailing Address - Phone:316-794-8655
Mailing Address - Fax:316-794-2433
Practice Address - Street 1:216 N MAIN
Practice Address - Street 2:
Practice Address - City:GODDARD
Practice Address - State:KS
Practice Address - Zip Code:67052
Practice Address - Country:US
Practice Address - Phone:316-794-8655
Practice Address - Fax:316-794-2433
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-20198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I41434Medicare UPIN
105209Medicare ID - Type Unspecified