Individual
AGNES SORIANO WALLBOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., M.S.
Contact information
Practice address
11301 WILSHIRE BLVD # 117, GLAVAHS DEPT PM&R, LOS ANGELES, CA 90073-1003
(310) 478-3711
(310) 268-4935
Mailing address
11301 WILSHIRE BLVD # 117, GLAVAHS DEPT PM&R, LOS ANGELES, CA 90073-1003
(310) 478-3711
(310) 268-4935
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
G078095
CA
Other
Enumeration date
07/01/2006
Last updated
07/08/2007
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