Healthcare Provider Details

I. General information

NPI: 1801712450
Provider Name (Legal Business Name): ANGELINE MAMONGAY SORIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 BLOSSOM WAY
HAYWARD CA
94541
US

IV. Provider business mailing address

1536 FRUITVALE AVE APT 8
OAKLAND CA
94601-2376
US

V. Phone/Fax

Practice location:
  • Phone: 510-582-7676
  • Fax:
Mailing address:
  • Phone: 510-541-1664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226000000X
TaxonomyRecreational Therapist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: