Provider Demographics
NPI:1063440717
Name:SOLA, AUGUSTO (MD)
Entity type:Individual
Prefix:
First Name:AUGUSTO
Middle Name:
Last Name:SOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S MAIN ST
Mailing Address - Street 2:SC, NEONATOLOGY
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3835
Mailing Address - Country:US
Mailing Address - Phone:714-509-4373
Mailing Address - Fax:714-509-7800
Practice Address - Street 1:455 S MAIN ST
Practice Address - Street 2:CS, NEONATOLOGY
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3835
Practice Address - Country:US
Practice Address - Phone:714-509-4373
Practice Address - Fax:714-509-7800
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32695208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063440717OtherCCS, NEONATOLOGY
CA1063440717Medicaid
CA1063440717Medicaid