Provider Demographics
NPI:1043760242
Name:SOLORIO, MIGUEL JR
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:SOLORIO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FRANCISCO JAVIER MINA 1415
Mailing Address - Street 2:STE 403 ZONA URBANA RIO
Mailing Address - City:TIJUANA
Mailing Address - State:BAJA CALIFORNIA
Mailing Address - Zip Code:22320
Mailing Address - Country:MX
Mailing Address - Phone:619-381-5645
Mailing Address - Fax:
Practice Address - Street 1:482 W SAN YSIDRO BLVD
Practice Address - Street 2:#134
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-2444
Practice Address - Country:US
Practice Address - Phone:619-381-5645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ4644837122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist