1679232425 NPI number — ELIZABETH SORIANO-CLARK IBCLC

Table of content: ELIZABETH SORIANO-CLARK IBCLC (NPI 1679232425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679232425 NPI number — ELIZABETH SORIANO-CLARK IBCLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SORIANO-CLARK
Provider First Name:
ELIZABETH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
IBCLC
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:
1679232425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
841 23RD ST # 41
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALIQUIPPA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15001-2784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-868-6646
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
545 NAVIGATION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15009-1809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-868-6646
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2021

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: 163WL0100X , with the licence number:  RN716127 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174N00000X , with the licence number: L-48664 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: L-48664 . This is a "HTTPS://WWW.IBCLE.ORG" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".