Healthcare Provider Details

I. General information

NPI: 1295699742
Provider Name (Legal Business Name): TIFFANY LAUREN SOLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 E DEL MAR BLVD APT 5 #5
PASADENA CA
91101-2777
US

IV. Provider business mailing address

327 E DEL MAR BLVD APT 5 #5
PASADENA CA
91101-2777
US

V. Phone/Fax

Practice location:
  • Phone: 323-383-3076
  • Fax:
Mailing address:
  • Phone: 323-383-3076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95388438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: