Healthcare Provider Details

I. General information

NPI: 1700446176
Provider Name (Legal Business Name): HANSER BEUNES SOLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16455 MAIN ST STE 1
HESPERIA CA
92345-3500
US

IV. Provider business mailing address

9383 DRAGON TREE DR
HESPERIA CA
92344-4680
US

V. Phone/Fax

Practice location:
  • Phone: 760-947-2161
  • Fax:
Mailing address:
  • Phone: 786-294-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number179426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: