=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346459872
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CECILIA SORIANO-CASACLANG, M.D INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3626 GRAND AVE SUITE A
-----------------------------------------------------
City | CHINO HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91709-1478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-364-0602
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3626 GRAND AVE SUITE A
-----------------------------------------------------
City | CHINO HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91709-1478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-364-0602
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MR. RENATO D CASACLANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-364-0602
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A46035
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------