Healthcare Provider Details

I. General information

NPI: 1770934804
Provider Name (Legal Business Name): TAMMY ANN SORO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMMY ANN NORRIS C.O.T.A.

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7776 CLEARFIELD AVE
PANORAMA CITY CA
91402-6508
US

IV. Provider business mailing address

7776 CLEARFIELD AVE
PANORAMA CITY CA
91402-6508
US

V. Phone/Fax

Practice location:
  • Phone: 520-403-9276
  • Fax:
Mailing address:
  • Phone: 520-403-9276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: