Healthcare Provider Details

I. General information

NPI: 1124418173
Provider Name (Legal Business Name): SORIANO MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 CLOVER POINT CIR
GUYTON GA
31312-7134
US

IV. Provider business mailing address

171 CLOVER POINT CIR
GUYTON GA
31312-7134
US

V. Phone/Fax

Practice location:
  • Phone: 407-702-8095
  • Fax:
Mailing address:
  • Phone: 407-702-8095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN19059
License Number StateSC

VIII. Authorized Official

Name: MR. DINO VINCENT SORIANO SR.
Title or Position: CEO
Credential: FNP-C
Phone: 407-702-8095