Provider Demographics
NPI:1982014437
Name:SORIANO, MARVIN (PA-C)
Entity type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:
Last Name:SORIANO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 5TH ST SE STE 4500
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4691
Mailing Address - Country:US
Mailing Address - Phone:253-792-6555
Mailing Address - Fax:
Practice Address - Street 1:1450 5TH ST SE STE 4500
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4691
Practice Address - Country:US
Practice Address - Phone:253-792-6555
Practice Address - Fax:253-697-4744
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60606165363AS0400X, 363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program