Individual
MR. SOL REISIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1550 NORTH IMPERIAL AVENUE, SUITE 1, EL CENTRO, CA 92243-4242
(760) 353-4710
(760) 545-0244
Mailing address
516 WEST ATEN ROAD, SUITE 2, IMPERIAL, CA 92251-9805
(760) 355-7730
(760) 355-7731
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A39697
CA
207RN0300X
Nephrology Physician
Primary
A39697
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A396970
—
CA
01
—
110111657
RAILROAD PIN#
CA
01
—
GR0066310
GROUP MEDI-CAL #
CA
01
—
W13536
MEDICARE GROUP #
CA
01
—
WA39697B
MEDICARE PTAN
CA
01
—
ZZZ47484Z
BLUE SHIELD ZZZ#
CA
Enumeration date
05/03/2006
Last updated
12/19/2016
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