Healthcare Provider Details

I. General information

NPI: 1063357200
Provider Name (Legal Business Name): ALEX PAC-DANIEL SOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 S MEADOWBROOK DR APT 48G
SAN DIEGO CA
92114-7664
US

IV. Provider business mailing address

382 S MEADOWBROOK DR APT 48G
SAN DIEGO CA
92114-7664
US

V. Phone/Fax

Practice location:
  • Phone: 619-495-3567
  • Fax:
Mailing address:
  • Phone: 619-495-3567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: