Healthcare Provider Details

I. General information

NPI: 1639093453
Provider Name (Legal Business Name): SHANE RAYOS DEL SOL, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18035 BROOKHURST ST STE 1100
FOUNTAIN VALLEY CA
92708-6738
US

IV. Provider business mailing address

18035 BROOKHURST ST STE 1100
FOUNTAIN VALLEY CA
92708-6738
US

V. Phone/Fax

Practice location:
  • Phone: 714-861-4888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SHANE RAYOS DEL SOL
Title or Position: PHYSICIAN
Credential: MD
Phone: 714-457-5866