Healthcare Provider Details

I. General information

NPI: 1407398704
Provider Name (Legal Business Name): ELIZABETH SOLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6945 OLD HIGHWAY 53
CLEARLAKE CA
95422-9381
US

IV. Provider business mailing address

6945 OLD HIGHWAY 53
CLEARLAKE CA
95422-9381
US

V. Phone/Fax

Practice location:
  • Phone: 707-995-9523
  • Fax:
Mailing address:
  • Phone: 707-995-9523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: