Healthcare Provider Details

I. General information

NPI: 1487019766
Provider Name (Legal Business Name): BERTHA SOLARES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E 4TH ST STE 200
SANTA ANA CA
92705-3916
US

IV. Provider business mailing address

2001 E 4TH ST STE 200
SANTA ANA CA
92705-3916
US

V. Phone/Fax

Practice location:
  • Phone: 714-824-8140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: