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General NPI Number Information
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NPI Number | 1205325065
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Entity Type | Individual
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Provider Name | QUEENIE SORIANO MS, ATC
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Gender | Female
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 5500 CAMPANILE DR
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City | SAN DIEGO
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State | CA
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Zip | 92182-0001
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Country | US
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Telephone | 619-594-1339
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Fax |
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Provider Business Mailing Address
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Address Line | 8510 LEMON AVE
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City | LA MESA
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State | CA
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Zip | 91941-5312
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Country | US
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Telephone | 505-331-3025
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 080402365
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License Number State | CA
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