=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508659467
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN LIMFUECO-SORIANO MS, ATC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2025
-----------------------------------------------------
Last Update Date | 05/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 241 S MORENO DR
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90212-3639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-229-3685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12350 DEL AMO BLVD APT 2715
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90715-1729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-580-9065
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 2000056531
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------