Provider Demographics
NPI:1518264290
Name:CECILIA N SORIANO-CASACLANG, MD, INC.
Entity type:Organization
Organization Name:CECILIA N SORIANO-CASACLANG, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:DICCION
Authorized Official - Last Name:CASACLANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-792-4417
Mailing Address - Street 1:1701 TORINO ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4752
Mailing Address - Country:US
Mailing Address - Phone:909-792-4417
Mailing Address - Fax:909-792-4417
Practice Address - Street 1:4950 SAN BERNARDINO ST STE 105
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2328
Practice Address - Country:US
Practice Address - Phone:909-625-4762
Practice Address - Fax:909-625-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46035208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A460350Medicaid