MEDICARE: DR. SUSANA V SANTIAGO-SORIANO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A68987	CA

General Provider Information

NPI Number	:	1376758490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSANA V SANTIAGO-SORIANO M.D.

Provider Business Mailing Address
First Line	:	3908 BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3407
Country	:	US
Telephone Number	:	213-388-2508
Fax Number	:

Provider Business Practice Location Address
First Line	:	3908 BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3407
Country	:	US
Telephone Number	:	213-388-2508
Fax Number	:	213-388-5377

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	03/26/2020

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