Provider Demographics
NPI:1992496541
Name:MACASIEB, STEVEN ADAM SORIANO
Entity type:Individual
Prefix:
First Name:STEVEN ADAM
Middle Name:SORIANO
Last Name:MACASIEB
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 1:4225 VERDUGO RD APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-4746
Mailing Address - Country:US
Mailing Address - Phone:323-835-5186
Mailing Address - Fax:
Practice Address - Street 1:400 W HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3470
Practice Address - Country:US
Practice Address - Phone:626-445-2421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50949225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant