Provider Demographics
NPI:1184870925
Name:SOLIS RIVERA, ISMAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:
Last Name:SOLIS RIVERA
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:D 19 URB VILLA MAR MEDITERRANEO
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:939-339-9288
Mailing Address - Fax:
Practice Address - Street 1:100 CII SATURNINO RODRIGUEZ
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-953-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN425208D00000X
PR17189208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14KV3OtherFL BLUE
FL1832364OtherWELLCARE
FL1832364OtherWELLCARE