Healthcare Provider Details

I. General information

NPI: 1669730586
Provider Name (Legal Business Name): ESTEVAN DARIO SOLARTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2012
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E CITRUS AVE STE A
REDLANDS CA
92374-4802
US

IV. Provider business mailing address

PO BOX 10069
SAN BERNARDINO CA
92423-0069
US

V. Phone/Fax

Practice location:
  • Phone: 909-794-3682
  • Fax:
Mailing address:
  • Phone: 909-335-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA135839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: