Healthcare Provider Details

I. General information

NPI: 1952811374
Provider Name (Legal Business Name): MARC THEODORE SORIANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W MAIN ST
BRAWLEY CA
92227-2244
US

IV. Provider business mailing address

26895 ALISO CREEK RD # B895
ALISO VIEJO CA
92656-5301
US

V. Phone/Fax

Practice location:
  • Phone: 760-344-5732
  • Fax:
Mailing address:
  • Phone: 949-243-6302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: