Healthcare Provider Details

I. General information

NPI: 1578102638
Provider Name (Legal Business Name): JANELLE EBONY SOLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date: 08/31/2021
Reactivation Date: 09/23/2021

III. Provider practice location address

426 N BLACKSTONE ST # CA93274
TULARE CA
93274-4449
US

IV. Provider business mailing address

426 N BLACKSTONE ST
TULARE CA
93274-4449
US

V. Phone/Fax

Practice location:
  • Phone: 559-688-2021
  • Fax: 559-687-7317
Mailing address:
  • Phone: 559-688-2021
  • Fax: 559-687-7317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number108946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: