Provider Demographics
NPI:1194060293
Name:SORIANO, REBECCA
Entity type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:
Last Name:SORIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 VAN NUYS BLVD
Mailing Address - Street 2:SUITE NUMBER 102
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2346
Mailing Address - Country:US
Mailing Address - Phone:818-376-0134
Mailing Address - Fax:
Practice Address - Street 1:6901 VAN NUYS BLVD
Practice Address - Street 2:SUITE NUMBER 102
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2346
Practice Address - Country:US
Practice Address - Phone:818-376-0134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77848225400000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner