Healthcare Provider Details

I. General information

NPI: 1689634123
Provider Name (Legal Business Name): SIMONETA SUMAGUE SORIANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 MARKS ST
HENDERSON NV
89014-6654
US

IV. Provider business mailing address

525 MARKS ST
HENDERSON NV
89014-6654
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-6210
  • Fax:
Mailing address:
  • Phone: 702-383-6210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11492
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: