Healthcare Provider Details

I. General information

NPI: 1770404477
Provider Name (Legal Business Name): ANAROSA SOLORIO MACIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14092 LAKESHORE DR
CLEARLAKE CA
95422-8160
US

IV. Provider business mailing address

PO BOX 1616
LOWER LAKE CA
95457-1616
US

V. Phone/Fax

Practice location:
  • Phone: 707-994-4261
  • Fax:
Mailing address:
  • Phone: 707-307-9041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1326252271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: