Healthcare Provider Details

I. General information

NPI: 1518264290
Provider Name (Legal Business Name): CECILIA N SORIANO-CASACLANG, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 SAN BERNARDINO ST STE 105
MONTCLAIR CA
91763-2328
US

IV. Provider business mailing address

1701 TORINO ST
REDLANDS CA
92374-4752
US

V. Phone/Fax

Practice location:
  • Phone: 909-625-4762
  • Fax: 909-625-4763
Mailing address:
  • Phone: 909-792-4417
  • Fax: 909-792-4417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA46035
License Number StateCA

VIII. Authorized Official

Name: MR. RENATO DICCION CASACLANG
Title or Position: CORPORATE TREASURER
Credential:
Phone: 909-792-4417