Basic Information
| Provider Information | |||||||||
| NPI: | 1093146292 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SORAJO | ||||||||
| FirstName: | MAMI | ||||||||
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| Credential: | R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2170 | ||||||||
| Address2: | |||||||||
| City: | SUMNER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983900480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538402313 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2904 4TH AVE NE | ||||||||
| Address2: | STE 300 | ||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983727053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538406448 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2013 | ||||||||
| LastUpdateDate: | 12/13/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DI 00001474 | WA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.