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General NPI Number Information
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NPI Number | 1518264290
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Entity Type | Organization
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Legal Business Name | CECILIA N SORIANO-CASACLANG, MD, INC.
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 08/08/2014
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Provider Practice Location Address
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Address Line | 4950 SAN BERNARDINO ST STE 105
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City | MONTCLAIR
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State | CA
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Zip | 91763-2328
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Country | US
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Telephone | 909-625-4762
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Fax | 909-625-4763
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Provider Business Mailing Address
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Address Line | 1701 TORINO ST
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City | REDLANDS
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State | CA
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Zip | 92374-4752
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Country | US
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Telephone | 909-792-4417
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Fax | 909-792-4417
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Authorized Official
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Title or Position | CORPORATE TREASURER
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Name | MR. RENATO DICCION CASACLANG
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Credential |
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Telephone | 909-792-4417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A46035
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License Number State | CA
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