Provider Demographics
NPI:1972288496
Name:SORIAL, MARIAM MEDHAT
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:MEDHAT
Last Name:SORIAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIAM
Other - Middle Name:MEDHAT
Other - Last Name:SAMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1851 N RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-8069
Mailing Address - Country:US
Mailing Address - Phone:909-421-2700
Mailing Address - Fax:
Practice Address - Street 1:1851 N RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8069
Practice Address - Country:US
Practice Address - Phone:909-421-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant