Provider Demographics
NPI:1720109614
Name:SORENSON, ERIK PATRICK (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:PATRICK
Last Name:SORENSON
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 1:1253 VALPARAISO DR E
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3930
Mailing Address - Country:US
Mailing Address - Phone:714-986-9915
Mailing Address - Fax:562-633-4996
Practice Address - Street 1:3650 SOUTH ST STE 306
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1516
Practice Address - Country:US
Practice Address - Phone:562-633-6353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16044363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant