Healthcare Provider Details

I. General information

NPI: 1093878548
Provider Name (Legal Business Name): SOFRONIO SORIANO PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 S JONES BLVD STE D3
LAS VEGAS NV
89103-3370
US

IV. Provider business mailing address

PO BOX 30844
LAS VEGAS NV
89173-0844
US

V. Phone/Fax

Practice location:
  • Phone: 702-750-2837
  • Fax: 702-750-2847
Mailing address:
  • Phone: 702-750-2837
  • Fax: 702-750-2847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: HENDRICA SORIANO
Title or Position: OFFICE MANAGER
Credential:
Phone: 702-750-2837