Provider Demographics
NPI:1912757550
Name:CHAVEZ-SORIANO, ANGELIQUE ALEXANDRIA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:ALEXANDRIA
Last Name:CHAVEZ-SORIANO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 ROCKY POINTE CT
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1992
Mailing Address - Country:US
Mailing Address - Phone:510-224-0098
Mailing Address - Fax:
Practice Address - Street 1:127 ROCKY POINTE CT
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1992
Practice Address - Country:US
Practice Address - Phone:510-224-0098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA620578163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse