Healthcare Provider Details

I. General information

NPI: 1861338428
Provider Name (Legal Business Name): MERCEDES LEANNE SORENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 MAGNOLIA AVE APT 202
LONG BEACH CA
90802-1218
US

IV. Provider business mailing address

630 MAGNOLIA AVE APT 202
LONG BEACH CA
90802-1218
US

V. Phone/Fax

Practice location:
  • Phone: 760-382-6190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberHXUOSA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: