Healthcare Provider Details

I. General information

NPI: 1760685861
Provider Name (Legal Business Name): BRIAN D SORIANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 11/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE # G-0035
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

PO BOX 50010
SEATTLE WA
98105-1010
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2015
  • Fax:
Mailing address:
  • Phone: 206-987-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number217598
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: