Healthcare Provider Details

I. General information

NPI: 1720109614
Provider Name (Legal Business Name): ERIK PATRICK SORENSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 SOUTH ST STE 306
LAKEWOOD CA
90712-1516
US

IV. Provider business mailing address

1253 VALPARAISO DR E
PLACENTIA CA
92870-3930
US

V. Phone/Fax

Practice location:
  • Phone: 562-633-6353
  • Fax:
Mailing address:
  • Phone: 714-986-9915
  • Fax: 562-633-4996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: