MEDICARE: SOBER LIFE RECOVERY SOLUTIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1083586523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOBER LIFE RECOVERY SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	3930 4TH AVE STE 300
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3119
Country	:	US
Telephone Number	:	619-542-9542
Fax Number	:	619-566-4979

Provider Business Practice Location Address
First Line	:	8619 JACKIE DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-1414
Country	:	US
Telephone Number	:	619-542-9542
Fax Number	:	619-566-4979

Authorized Official
Title or Position	:	CEO
Name	:	DEOMEL SORIANO
Credential	:	PMHNP
Telephone Number	:	619-542-9542

Provider Enumeration Date	:	09/23/2025
Last Update Date	:	03/18/2026

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Directions to “SOBER LIFE RECOVERY SOLUTIONS LLC ” Practice Location

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