Healthcare Provider Details

I. General information

NPI: 1467407411
Provider Name (Legal Business Name): EDITA SORIANO AGUILAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 N DATE ST
ESCONDIDO CA
92025-3409
US

IV. Provider business mailing address

425 N DATE ST
ESCONDIDO CA
92025-3413
US

V. Phone/Fax

Practice location:
  • Phone: 760-690-5900
  • Fax: 760-747-9980
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA56054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: