1588632970 NPI number — SOLA SERVICIOS MEDICOS INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588632970 NPI number — SOLA SERVICIOS MEDICOS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLA SERVICIOS MEDICOS INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588632970
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HORMIGUEROS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00660-0207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-805-2010
Provider Business Mailing Address Fax Number:
787-805-2010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE VICENTE RAMOS COLON
Provider Second Line Business Practice Location Address:
POBLADO ROSARIO
Provider Business Practice Location Address City Name:
ROSARIO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-805-2010
Provider Business Practice Location Address Fax Number:
787-805-2010
Provider Enumeration Date:
03/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-805-2010

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 53102 . This is a "TRIPLE SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6990 . This is a "AMERICAN HEALTH MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 50217 . This is a "PREFERRED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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