Provider Demographics
NPI:1164213351
Name:RO, SORAH (NP)
Entity type:Individual
Prefix:
First Name:SORAH
Middle Name:
Last Name:RO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SO RAH
Other - Middle Name:
Other - Last Name:RO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:4243 TROLAN LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-4680
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4243 TROLAN LN
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-4680
Practice Address - Country:US
Practice Address - Phone:650-445-1194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95226392163W00000X
CA95034032363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse