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General NPI Number Information
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NPI Number | 1770703282
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Entity Type | Organization
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Legal Business Name | ALEXANDER SOROKURS, MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 1024 OXFORD AVE
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5409
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Country | US
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Telephone | 310-306-5502
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12973
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City | MARINA DEL REY
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State | CA
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Zip | 90295-3973
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Country | US
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Telephone | 310-306-5502
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALEXANDER SOROKURS
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Credential | MD
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Telephone | 310-306-5502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | A54193
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License Number State | CA
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