Provider Demographics
NPI:1972658516
Name:SOLIS DIAZ, AWILDA (MD)
Entity Type:Individual
Prefix:DR
First Name:AWILDA
Middle Name:
Last Name:SOLIS DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-0488
Mailing Address - Country:US
Mailing Address - Phone:787-893-8204
Mailing Address - Fax:787-266-0180
Practice Address - Street 1:CRISTOBAL COLON ST
Practice Address - Street 2:SUITE 10
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-893-8204
Practice Address - Fax:787-266-0180
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7061208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG40272Medicare UPIN
PR0028110Medicare ID - Type Unspecified