Provider Demographics
NPI:1184164022
Name:SORIA, DARYL MADAYAG
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:MADAYAG
Last Name:SORIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DARYL MAE
Other - Middle Name:MADAYAG
Other - Last Name:SORIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN-FNP
Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:656 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4113
Practice Address - Country:US
Practice Address - Phone:510-818-9237
Practice Address - Fax:510-818-9222
Is Sole Proprietor?:No
Enumeration Date:2017-02-25
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005880363LF0000X
CANP95005880363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95005880OtherFURNISHING NUMBER
CA95005880OtherNURSE PRACTITIONER LICENSE