Provider Demographics
NPI:1336147040
Name:SORIA, RAFAEL R (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:R
Last Name:SORIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E TUOLUMNE RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-1543
Mailing Address - Country:US
Mailing Address - Phone:209-668-4101
Mailing Address - Fax:209-668-3758
Practice Address - Street 1:911 E TUOLUMNE RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1543
Practice Address - Country:US
Practice Address - Phone:209-668-4101
Practice Address - Fax:209-668-3758
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A617350Medicaid
CA00A617350Medicaid
CAG45068Medicare UPIN