Healthcare Provider Details

I. General information

NPI: 1407191067
Provider Name (Legal Business Name): MARIA ANTONIETA SORENSEN M. C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA ANTONIETA SANCHEZ M. C.

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E COTTONWOOD LN
CASA GRANDE AZ
85122-2514
US

IV. Provider business mailing address

5543 N PALO VERDE VISTA PL
TUCSON AZ
85745-8610
US

V. Phone/Fax

Practice location:
  • Phone: 866-836-1688
  • Fax: 520-876-1796
Mailing address:
  • Phone: 520-235-0765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 13664
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: