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NPI Code Detail

MEDICARE: MARINE SORIANO M.A.

MEDICARE: MARINE SORIANO M.A.
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
1106H00000XMarriage & Family TherapistIMF74862CA
2106H00000XMarriage & Family Therapist113241CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1IMF74862OTHERCABOARD OF BEHAVIORAL SCIENCES
2LMFT113241OTHERCABOARD OF BEHAVIORAL SCIENCES

General Provider Information

NPI Number : 1386907962
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARINE SORIANO M.A.
Provider Business Mailing Address
First Line : PO BOX 79
Second Line :
City : CABAZON
State : CA
Zip : 92230-0079
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15455 SAN FERNANDO MISSION BLVD STE 300
Second Line :
City : MISSION HILLS
State : CA
Zip : 91345-1353
Country : US
Telephone Number : 818-330-4782
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2012
Last Update Date : 06/29/2021

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Directions to “ MARINE SORIANO M.A.” Practice Location

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