Provider Demographics
NPI:1124464219
Name:SOPRANO, JOSEPH FREDERICK
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:FREDERICK
Last Name:SOPRANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9053 RICH AMETHYST CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-0603
Mailing Address - Country:US
Mailing Address - Phone:702-339-1543
Mailing Address - Fax:
Practice Address - Street 1:5659 DUNCAN DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2811
Practice Address - Country:US
Practice Address - Phone:702-385-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator