Provider Demographics
NPI:1770934804
Name:SORO, TAMMY ANN
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:ANN
Last Name:SORO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:ANN
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:7776 CLEARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-6508
Mailing Address - Country:US
Mailing Address - Phone:520-403-9276
Mailing Address - Fax:
Practice Address - Street 1:7776 CLEARFIELD AVE
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-6508
Practice Address - Country:US
Practice Address - Phone:520-403-9276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2114314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility