Healthcare Provider Details

I. General information

NPI: 1083359582
Provider Name (Legal Business Name): ELIZABETH JUANA SOLIS CMT, NMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 PINE ST
RED BLUFF CA
96080-3313
US

IV. Provider business mailing address

525 LINCOLN ST
RED BLUFF CA
96080-3728
US

V. Phone/Fax

Practice location:
  • Phone: 530-715-1619
  • Fax:
Mailing address:
  • Phone: 530-712-0369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number84752
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: