Healthcare Provider Details

I. General information

NPI: 1407575475
Provider Name (Legal Business Name): SOALIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL MENONITA CAGUAS CARR. 172 URB TURABO GARDENS
CAGUAS PR
00725
US

IV. Provider business mailing address

1520 AVE ASHFORD APT 5
SAN JUAN PR
00911-1115
US

V. Phone/Fax

Practice location:
  • Phone: 787-286-0941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: EDRIC VIVONI
Title or Position: MEMBER
Credential:
Phone: 787-286-0941