Basic Information
| Provider Information | |||||||||
| NPI: | 1316001209 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EL SOL FAMILY MEDICINE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2260 N ROSEMONT BLVD | ||||||||
| Address2: | STE 107 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857122137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203181033 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2260 N ROSEMONT BLVD | ||||||||
| Address2: | STE 107 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857122137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203181033 | ||||||||
| FaxNumber: | 5203181338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2006 | ||||||||
| LastUpdateDate: | 01/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | LEVINE | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5203181033 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21943 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 07-582591X | 05 | AZ | MEDICAID |