Healthcare Provider Details

I. General information

NPI: 1063376341
Provider Name (Legal Business Name): SAMUEL SOLIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 WALNUT AVE
SANTA CRUZ CA
95060-3633
US

IV. Provider business mailing address

28 VISTA POINTE DR
WATSONVILLE CA
95076-6612
US

V. Phone/Fax

Practice location:
  • Phone: 831-429-3960
  • Fax:
Mailing address:
  • Phone: 831-840-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: