Basic Information
| Provider Information | |||||||||
| NPI: | 1134210263 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SORIANO | ||||||||
| FirstName: | JENNY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 361 3RD ST | ||||||||
| Address2: | SUITE E | ||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949013541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154994030 | ||||||||
| FaxNumber: | 4155072634 | ||||||||
| Practice Location | |||||||||
| Address1: | 361 3RD ST | ||||||||
| Address2: | SUITE E | ||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949013541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154994030 | ||||||||
| FaxNumber: | 4155072634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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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 | 207V00000X | G62206 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00G622060 | 05 | CA | MEDICAID |