=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023001765
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTONIO H SOLER SALAS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2005
-----------------------------------------------------
Last Update Date | 09/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARIMED PLZ B-1 CALLE SANTA CRUZ SUITE 403-404
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00961-6928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-798-7070
-----------------------------------------------------
Fax | 787-787-2107
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PMB 163 1353 CARR 19
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00966-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-798-7070
-----------------------------------------------------
Fax | 787-787-2107
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | 9185
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------