Provider Demographics
NPI:1245301365
Name:SOLIS BAZAN, EDWIN (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:SOLIS BAZAN
Suffix:
Gender:M
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:CALLE VIRGILIO SANCHEZ #53
Mailing Address - Street 2:
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714-0415
Mailing Address - Country:US
Mailing Address - Phone:787-839-1740
Mailing Address - Fax:787-839-1845
Practice Address - Street 1:53 CALLE VIRGILIO SANCHEZ
Practice Address - Street 2:
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714-2641
Practice Address - Country:US
Practice Address - Phone:787-839-1740
Practice Address - Fax:787-839-1845
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10377208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF28866Medicare UPIN
PR82664Medicare ID - Type UnspecifiedEDWIN SOLIS