Healthcare Provider Details

I. General information

NPI: 1104780063
Provider Name (Legal Business Name): GUS JR SOLIS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 FLORIDA AVE
MODESTO CA
95350-4418
US

IV. Provider business mailing address

1441 FLORIDA AVE HOSPITALIST SUITE
MODESTO CA
95350-4404
US

V. Phone/Fax

Practice location:
  • Phone: 626-484-5448
  • Fax:
Mailing address:
  • Phone: 626-484-5448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number67720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: