Provider Demographics
NPI:1255681102
Name:SOLANO, JOSE GREGORIO (IDC)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:GREGORIO
Last Name:SOLANO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BHC DIEGO GARCIA PSC 466
Mailing Address - Street 2:BOX 3
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96595-0003
Mailing Address - Country:US
Mailing Address - Phone:315-370-4220
Mailing Address - Fax:
Practice Address - Street 1:BRANCH HEALTH CLINIC DIEGO GARCIA
Practice Address - Street 2:PSC 466 BOX 3
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96595-0003
Practice Address - Country:US
Practice Address - Phone:246-370-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman