| Solace Medical Group LLC | |
|
4739 Old Canoe Creek Rd Saint Cloud FL 34769-1400 | |
| (321) 327-8336 | |
| Not Available |
| Full Name | Solace Medical Group LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 4739 Old Canoe Creek Rd, Saint Cloud, Florida |
| Authorized Official Name and Position | Luis Alvarado (CMO) |
| Authorized Official Contact | 4077174159 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Solace Medical Group LLC 10524 Moss Park Rd Ste 204-750 Orlando FL 32832-5898 | Solace Medical Group LLC 4739 Old Canoe Creek Rd Saint Cloud FL 34769-1400 Ph: (321) 327-8336 |
| NPI Number | 1962105627 |
|---|---|
| Provider Enumeration Date | 03/22/2023 |
| Last Update Date | 07/14/2023 |
| Certification Date | 07/14/2023 |
| Medicare PECOS PAC ID | 7719352608 |
|---|---|
| Medicare Enrollment ID | O20230406000793 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962105627 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
| Provider Name | Luis R Alvarado Lopez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467424143 PECOS PAC ID: 7517125347 Enrollment ID: I20160926000676 |
| Provider Name | Nivia Elis Rodriguez Villanueva |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1780242586 PECOS PAC ID: 0547687543 Enrollment ID: I20200903003378 |
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