1184164022 NPI number — DARYL MADAYAG SORIA

Table of content: DARYL MADAYAG SORIA (NPI 1184164022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184164022 NPI number — DARYL MADAYAG SORIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SORIA
Provider First Name:
DARYL
Provider Middle Name:
MADAYAG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SORIA
Provider Other First Name:
DARYL MAE
Provider Other Middle Name:
MADAYAG
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN-FNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1184164022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2350 W EL CAMINO REAL FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN VIEW
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94040-6203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
656 MOWRY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94536-4113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-818-9237
Provider Business Practice Location Address Fax Number:
510-818-9222
Provider Enumeration Date:
02/25/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  95005880 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: NP95005880 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 95005880 . This is a "FURNISHING NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 95005880 . This is a "NURSE PRACTITIONER LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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