Healthcare Provider Details

I. General information

NPI: 1104313402
Provider Name (Legal Business Name): JORGE L SOLER IGLESIAS NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JORGE LUIS SOLER IGLESIAS NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12740 HESPERIA RD
VICTORVILLE CA
92395-8306
US

IV. Provider business mailing address

12740 HESPERIA RD STE A
VICTORVILLE CA
92395-8306
US

V. Phone/Fax

Practice location:
  • Phone: 760-713-6969
  • Fax: 760-245-9448
Mailing address:
  • Phone: 760-713-6969
  • Fax: 760-245-9448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11038363
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: