Healthcare Provider Details

I. General information

NPI: 1760330435
Provider Name (Legal Business Name): SOBER LIFE RECOVERY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12030 REDCLIFF CT
SAN DIEGO CA
92131-2617
US

IV. Provider business mailing address

3930 4TH AVE STE 300
SAN DIEGO CA
92103-3119
US

V. Phone/Fax

Practice location:
  • Phone: 619-542-9542
  • Fax: 619-566-4979
Mailing address:
  • Phone: 619-542-9542
  • Fax: 619-566-4979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DEOMEL M SORIANO
Title or Position: CEO
Credential: NP
Phone: 858-414-0371