Healthcare Provider Details

I. General information

NPI: 1326816075
Provider Name (Legal Business Name): MARIA FATIMA JOSELYN SORIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2313 S MOUNT PROSPECT RD
DES PLAINES IL
60018-1811
US

IV. Provider business mailing address

1924 N 76TH AVE
ELMWOOD PARK IL
60707-3604
US

V. Phone/Fax

Practice location:
  • Phone: 847-635-3000
  • Fax:
Mailing address:
  • Phone: 773-895-4453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number051295010
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: