1366585531 NPI number — MISS CARMEN HELENA SORISHO M.A.

Table of content: MISS CARMEN HELENA SORISHO M.A. (NPI 1366585531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366585531 NPI number — MISS CARMEN HELENA SORISHO M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SORISHO
Provider First Name:
CARMEN
Provider Middle Name:
HELENA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366585531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2087
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERCED
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95344-0087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-385-3000
Provider Business Mailing Address Fax Number:
209-354-2513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2115 WARDROBE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERCED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95341-6445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-385-3000
Provider Business Practice Location Address Fax Number:
209-354-2513
Provider Enumeration Date:
02/15/2007

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: 101YM0800X , with the licence number:  IMF 57273 , 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)





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