Provider Demographics
NPI:1871507376
Name:SORIANO, NATHANIEL (CRNA)
Entity type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:
Last Name:SORIANO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 SASSAFRAS DR
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5027
Mailing Address - Country:US
Mailing Address - Phone:661-633-2300
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF ROUTE N12 AND N7
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2307367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN3301300Medicaid
CANA0023070OtherBLUE SHIELD OF CALIFORNIA
CACA122700Medicare PIN
CAZZZ04390ZMedicare PIN
CANA0023070OtherBLUE SHIELD OF CALIFORNIA
CAP00675127Medicare PIN
CAP01172182Medicare PIN