Healthcare Provider Details

I. General information

NPI: 1346780616
Provider Name (Legal Business Name): DONALD SORIANO SORTONIS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 06/07/2021
Certification Date: 05/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 PLAZA DR
CYPRESS CA
90630-5000
US

IV. Provider business mailing address

325 BEAR CREEK DR
BRENTWOOD CA
94513-4287
US

V. Phone/Fax

Practice location:
  • Phone: 505-798-6248
  • Fax:
Mailing address:
  • Phone: 785-230-7356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number77492
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number53-77492-062
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-77492-062
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: