Provider Demographics
NPI:1902150865
Name:SORIANO-SAMSON, ANNA MARIE (NP-C)
Entity type:Individual
Prefix:
First Name:ANNA MARIE
Middle Name:
Last Name:SORIANO-SAMSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31736 MISSION TRL STE G
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4533
Mailing Address - Country:US
Mailing Address - Phone:951-674-1505
Mailing Address - Fax:
Practice Address - Street 1:31736 MISSION TRL STE G
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4533
Practice Address - Country:US
Practice Address - Phone:951-674-1505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily