Provider Demographics
NPI:1700866894
Name:SOLIGUEN, MAX VINCO (MD)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:VINCO
Last Name:SOLIGUEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6246 INDIGO AVE
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-2551
Mailing Address - Country:US
Mailing Address - Phone:909-466-9160
Mailing Address - Fax:909-466-9160
Practice Address - Street 1:1183 E FOOTHILL BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-920-9050
Practice Address - Fax:909-920-9057
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA56150208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A561500Medicaid