Healthcare Provider Details

I. General information

NPI: 1023079852
Provider Name (Legal Business Name): CAROLINA M SORIA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 N MAIN
GODDARD KS
67052
US

IV. Provider business mailing address

PO BOX 764
WICHITA KS
67201-0764
US

V. Phone/Fax

Practice location:
  • Phone: 316-794-8655
  • Fax: 316-794-2433
Mailing address:
  • Phone: 316-794-8655
  • Fax: 316-794-2433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-20198
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: