Provider Demographics
NPI:1215049150
Name:SOLIVAN, RUBEN TORRES
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:TORRES
Last Name:SOLIVAN
Suffix:
Gender:M
Credentials:
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 3795
Mailing Address - Street 2:CALLE 4 20 GARDEN HILLS ESTATES
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-792-0313
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA PONCE DE LEON
Practice Address - Street 2:714
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-751-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3726207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
24663Medicare ID - Type Unspecified
C77248Medicare UPIN