MEDICARE: SOL MEDICAL CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1780491712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOL MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	4710 N HABANA AVE STE 304
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-7151
Country	:	US
Telephone Number	:	813-930-5011
Fax Number	:	813-930-5007

Provider Business Practice Location Address
First Line	:	4710 N HABANA AVE STE 304
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-7151
Country	:	US
Telephone Number	:	813-930-5011
Fax Number	:	813-930-5007

Authorized Official
Title or Position	:	MANAGER MEMBER
Name	:	LIAMARELIS HURTADO HERNANDEZ
Credential	:
Telephone Number	:	813-693-8034

Provider Enumeration Date	:	12/12/2024
Last Update Date	:	01/13/2026

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Directions to “SOL MEDICAL CENTER LLC ” Practice Location

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