Healthcare Provider Details

I. General information

NPI: 1447534185
Provider Name (Legal Business Name): MARITONI P SORIANO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S HOBART BLVD APT 102
LOS ANGELES CA
90020-3701
US

IV. Provider business mailing address

520 S HOBART BLVD APT 102
LOS ANGELES CA
90020-3701
US

V. Phone/Fax

Practice location:
  • Phone: 213-820-3506
  • Fax:
Mailing address:
  • Phone: 213-820-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number847613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: