Provider Demographics
NPI:1760363774
Name:DE LA ROSA SORIANO, JONATAN
Entity type:Individual
Prefix:
First Name:JONATAN
Middle Name:
Last Name:DE LA ROSA SORIANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 SANDERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8877
Mailing Address - Country:US
Mailing Address - Phone:859-693-4206
Mailing Address - Fax:
Practice Address - Street 1:3032 SANDERSVILLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-8877
Practice Address - Country:US
Practice Address - Phone:859-693-4206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty