Provider Demographics
NPI:1568030781
Name:SOLANA BORREGO, MARIO LUIS (MD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:LUIS
Last Name:SOLANA BORREGO
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 1:711 NW 23RD AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3395
Mailing Address - Country:US
Mailing Address - Phone:305-541-3881
Mailing Address - Fax:305-642-9534
Practice Address - Street 1:711 NW 23RD AVE STE 305
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3395
Practice Address - Country:US
Practice Address - Phone:305-541-3881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32260207Q00000X
FLME165446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine