Provider Demographics
NPI:1992086581
Name:SORIA, ELIASAR GONZALES (RASI)
Entity type:Individual
Prefix:
First Name:ELIASAR
Middle Name:GONZALES
Last Name:SORIA
Suffix:
Gender:M
Credentials:RASI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9028 NEWHALL DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-5104
Mailing Address - Country:US
Mailing Address - Phone:916-363-4840
Mailing Address - Fax:
Practice Address - Street 1:9028 NEWHALL DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-5104
Practice Address - Country:US
Practice Address - Phone:916-363-4840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)