Provider Demographics
NPI:1104313402
Name:SOLER IGLESIAS, JORGE L (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:L
Last Name:SOLER IGLESIAS
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:MR
Other - First Name:JORGE
Other - Middle Name:LUIS
Other - Last Name:SOLER IGLESIAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:12459 CRICKET ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-4842
Mailing Address - Country:US
Mailing Address - Phone:786-287-8675
Mailing Address - Fax:
Practice Address - Street 1:12459 CRICKET ST.
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392
Practice Address - Country:US
Practice Address - Phone:786-287-8675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily