Healthcare Provider Details

I. General information

NPI: 1710553607
Provider Name (Legal Business Name): KIMBERLY BACLAYON SORIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W CARSON ST
CARSON CA
90745-2601
US

IV. Provider business mailing address

11943 BOS ST
CERRITOS CA
90703-6904
US

V. Phone/Fax

Practice location:
  • Phone: 310-549-6500
  • Fax:
Mailing address:
  • Phone: 562-608-7747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number84287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: