Healthcare Provider Details

I. General information

NPI: 1982593430
Provider Name (Legal Business Name): ESMERALDA SOLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ESMERALDA MARIN

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1477
CRESTLINE CA
92325-1477
US

IV. Provider business mailing address

PO BOX 1477
CRESTLINE CA
92325-1477
US

V. Phone/Fax

Practice location:
  • Phone: 187-242-8788
  • Fax:
Mailing address:
  • Phone: 818-724-2878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: