Provider Demographics
NPI:1386420776
Name:SOLORIO, NICODEMUS REID (PA-C)
Entity type:Individual
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First Name:NICODEMUS
Middle Name:REID
Last Name:SOLORIO
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:815 N CENTRAL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-5873
Mailing Address - Country:US
Mailing Address - Phone:541-734-9030
Mailing Address - Fax:
Practice Address - Street 1:1600 DELTA WATERS RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9114
Practice Address - Country:US
Practice Address - Phone:541-858-2515
Practice Address - Fax:541-858-2514
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant