Healthcare Provider Details

I. General information

NPI: 1891760625
Provider Name (Legal Business Name): JOSE SORIANO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8-18 EUSTIS STREET
EUSTIS FL
32726
US

IV. Provider business mailing address

16140 US HIGHWAY 441
EUSTIS FL
32726-6508
US

V. Phone/Fax

Practice location:
  • Phone: 352-589-6424
  • Fax: 352-589-6496
Mailing address:
  • Phone: 352-589-6424
  • Fax: 352-589-6496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME90608
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: