Healthcare Provider Details

I. General information

NPI: 1528786191
Provider Name (Legal Business Name): JOANNA LOPEZ SOLORIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 N VAN NESS AVE
FRESNO CA
93728-3429
US

IV. Provider business mailing address

7120 N MARKS AVE STE 110
FRESNO CA
93711-0268
US

V. Phone/Fax

Practice location:
  • Phone: 559-268-7613
  • Fax:
Mailing address:
  • Phone: 559-439-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: