Provider Demographics
NPI:1093523409
Name:SORIANO-FERNANDEZ, MIGUEL ADRIAN (LMT)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ADRIAN
Last Name:SORIANO-FERNANDEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25529 GOLD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-5451
Mailing Address - Country:US
Mailing Address - Phone:702-493-8078
Mailing Address - Fax:
Practice Address - Street 1:1333 WILLOW PASS RD STE 110
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5225
Practice Address - Country:US
Practice Address - Phone:925-892-4639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96272225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist