Provider Demographics
NPI:1740484450
Name:SORIANO, MIGUEL ANGEL
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:SORIANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 FREEDOM BLVD
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2780
Mailing Address - Country:US
Mailing Address - Phone:831-763-8623
Mailing Address - Fax:831-763-8591
Practice Address - Street 1:1430 FREEDOM BLVD
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2780
Practice Address - Country:US
Practice Address - Phone:831-763-8872
Practice Address - Fax:831-763-8591
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA5373500OtherDRIVER LICENCE