Provider Demographics
NPI:1134210263
Name:SORIANO, JENNY (MD)
Entity type:Individual
Prefix:
First Name:JENNY
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 1:361 3RD ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3541
Mailing Address - Country:US
Mailing Address - Phone:415-499-4030
Mailing Address - Fax:415-507-2634
Practice Address - Street 1:361 3RD ST
Practice Address - Street 2:SUITE E
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3541
Practice Address - Country:US
Practice Address - Phone:415-499-4030
Practice Address - Fax:415-507-2634
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62206207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G622060Medicaid
CA00G622061Medicare ID - Type UnspecifiedNHIC MEDICARE ID
CA00G622060Medicaid