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General NPI Number Information
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NPI Number | 1336296565
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Entity Type | Organization
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Legal Business Name | SUSANA SANTIAGO-SORIANO MD INC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 3908 BEVERLY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90004-3407
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Country | US
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Telephone | 213-388-2508
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Fax | 213-388-5377
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Provider Business Mailing Address
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Address Line | 3908 BEVERLY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90004-3407
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Country | US
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Telephone | 213-388-2508
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Fax | 213-388-5377
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSANA VISDA SANTIAGO-SORIANO
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Credential | M.D.
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Telephone | 213-388-2508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A68987
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License Number State | CA
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