Provider Demographics
NPI:1629386396
Name:SORIANO, LUIS D'MONTIQUE (PA-C)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:D'MONTIQUE
Last Name:SORIANO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 BEL AIRE DR W
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2220
Mailing Address - Country:US
Mailing Address - Phone:786-316-1211
Mailing Address - Fax:
Practice Address - Street 1:1220 BEL AIRE DR W
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-2220
Practice Address - Country:US
Practice Address - Phone:786-316-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105637363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical