MEDICARE: SUSANA SANTIAGO-SORIANO

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

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	:	1477696714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSANA SANTIAGO-SORIANO

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	:	213-388-5377

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	:	PHYSICIAN
Name	:	DR. SUSANA V SANTIAGO-SORIANO
Credential	:	MD
Telephone Number	:	213-388-2508

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	08/22/2020

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Directions to “SUSANA SANTIAGO-SORIANO ” Practice Location

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