MEDICARE: CLINICA DEL SOL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	D1496	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750557963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA DEL SOL PA

Provider Business Mailing Address
First Line	:	6206 DASHWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4214
Country	:	US
Telephone Number	:	713-778-1904
Fax Number	:	713-778-0130

Provider Business Practice Location Address
First Line	:	6206 DASHWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4214
Country	:	US
Telephone Number	:	713-778-1904
Fax Number	:	713-778-0130

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. SELIC SOROKA
Credential	:	MD
Telephone Number	:	713-778-1904

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	05/07/2008

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Directions to “CLINICA DEL SOL PA ” Practice Location

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