Healthcare Provider Details

I. General information

NPI: 1376388637
Provider Name (Legal Business Name): SOLANA PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 E CHANDLER BLVD STE 112-1160
PHOENIX AZ
85048-0441
US

IV. Provider business mailing address

4611 E CHANDLER BLVD STE 112-1160
PHOENIX AZ
85048-0441
US

V. Phone/Fax

Practice location:
  • Phone: 602-899-9800
  • Fax: 602-562-6032
Mailing address:
  • Phone: 602-899-9800
  • Fax: 602-562-6032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT BEUKEMA
Title or Position: MEMBER
Credential: DNP
Phone: 602-899-9800