Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A32695 | CA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | A32695 | CA |
NPI | 1063440717 |
---|---|
Provider Name | Augusto Sola |
First Address | Orange, CA 92868-3835 |
Second Address | Orange, CA 92868-3835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 11/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063440717 | (02) | CA |
1063440717 | (05) | CA |
1063440717 | CCS, NEONATOLOGY (01) | CA |