Healthcare Provider Details

I. General information

NPI: 1003529538
Provider Name (Legal Business Name): SOL AILEN CASELLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S WINCHESTER BLVD # B-1101
SAN JOSE CA
95128-3901
US

IV. Provider business mailing address

2635 ZANKER RD
SAN JOSE CA
95134-2107
US

V. Phone/Fax

Practice location:
  • Phone: 408-484-1028
  • Fax:
Mailing address:
  • Phone: 408-292-9353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: