Healthcare Provider Details

I. General information

NPI: 1508659467
Provider Name (Legal Business Name): MEGAN LIMFUECO-SORIANO MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 S MORENO DR
BEVERLY HILLS CA
90212-3639
US

IV. Provider business mailing address

12350 DEL AMO BLVD APT 2715
LAKEWOOD CA
90715-1729
US

V. Phone/Fax

Practice location:
  • Phone: 310-229-3685
  • Fax:
Mailing address:
  • Phone: 714-580-9065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000056531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: