Healthcare Provider Details

I. General information

NPI: 1023630506
Provider Name (Legal Business Name): ELIZABETH SOLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 VISTA WAY
OCEANSIDE CA
92054-5661
US

IV. Provider business mailing address

10790 RANCHO BERNARDO ROAD MAIL DROP 4S-205
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 760-280-7464
  • Fax:
Mailing address:
  • Phone: 760-633-6507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: