Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 08142R | LA |
Y | 2080P0201X | Pediatric Allergist | 08142R | LA |
NPI | 1730100751 |
---|---|
Provider Name | Ricardo U Sorensen |
First Address | New Orleans, LA 70118-5720 |
Second Address | New Orleans, LA 70118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2006 |
Last Update Date | 03/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00114172 | (05) | MS |
1394572 | (05) | LA |
D31222 | (02) |