MEDICARE: EUGENE SOROKA MD

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	207Q00000X	Family Medicine Physician	A93249	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437109683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE SOROKA MD

Provider Business Mailing Address
First Line	:	4611 VISTA DEL MONTE AVE
Second Line	:	UNIT 204
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-2944
Country	:	US
Telephone Number	:	818-674-7838
Fax Number	:	805-247-0508

Provider Business Practice Location Address
First Line	:	246 E SCOTT STREET
Second Line	:
City	:	PORT HUENEME
State	:	CA
Zip	:	93041-2918
Country	:	US
Telephone Number	:	805-247-0708
Fax Number	:	805-247-0508

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	01/14/2008

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