Provider Demographics
NPI:1124112289
Name:SOLIS, HERIBERTO (MD)
Entity type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:
Last Name:SOLIS
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:PO BOX 2545
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00951-2545
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 AVE LUIS MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-2449
Practice Address - Country:US
Practice Address - Phone:787-794-1305
Practice Address - Fax:787-794-1305
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2016660OtherPREFERRED
PR50077EOtherMEDICARE Y MUCHO MAS
PR6460035OtherHUMANA
PR065402OtherLA CRUZ AZUL
PR119-11093OtherGLOBAL HEALTH PLAN
PR2096OtherAMERICAN HEALTH
PR83357Medicaid
PR1046OtherFIRST MEDICAL/FIRST PLUS
PRF94491Medicare UPIN
PR0083357Medicare ID - Type Unspecified