Healthcare Provider Details

I. General information

NPI: 1639086168
Provider Name (Legal Business Name): MIRIAM ROSARIO SOLORIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ENRIQUE SOLORIO

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8189 HEARTLAND CIRCLE
OAK HILLS CA
92344
US

IV. Provider business mailing address

PO BOX 400357
HESPERIA CA
92340-0357
US

V. Phone/Fax

Practice location:
  • Phone: 951-756-6076
  • Fax:
Mailing address:
  • Phone: 951-756-6076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberD4132391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: