Healthcare Provider Details

I. General information

NPI: 1306307780
Provider Name (Legal Business Name): CHRISTIAN-IMMANUEL SORIANO OLIVEROS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD # HD407
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

P O BOX BOX 100296
GAINESVILLE FL
32610-0001
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5437
  • Fax:
Mailing address:
  • Phone: 352-627-9350
  • Fax: 352-273-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2019018167
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9409841
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME174065
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License NumberME174065
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: