Healthcare Provider Details

I. General information

NPI: 1457729998
Provider Name (Legal Business Name): CATHERINE SORIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 E CHEVES ST
FLORENCE SC
29506-2710
US

IV. Provider business mailing address

1204 E CHEVES ST
FLORENCE SC
29506-2710
US

V. Phone/Fax

Practice location:
  • Phone: 843-673-0122
  • Fax: 843-661-6400
Mailing address:
  • Phone: 843-673-0122
  • Fax: 843-661-6400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTL2408
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberTL2408
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberTL2408
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: