Healthcare Provider Details

I. General information

NPI: 1558024646
Provider Name (Legal Business Name): SOLACE BAYLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 S MOONEY BLVD
VISALIA CA
93277-6240
US

IV. Provider business mailing address

908 S LIBERTY ST
VISALIA CA
93292-2910
US

V. Phone/Fax

Practice location:
  • Phone: 559-733-0770
  • Fax: 559-733-3616
Mailing address:
  • Phone: 805-907-5631
  • Fax: 559-733-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number98027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: