Healthcare Provider Details

I. General information

NPI: 1245894260
Provider Name (Legal Business Name): ROBERT SOLIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9829 CARMENITA RD
WHITTIER CA
90605-3229
US

IV. Provider business mailing address

665 LARIMORE AVE
LA PUENTE CA
91744-3025
US

V. Phone/Fax

Practice location:
  • Phone: 562-907-7429
  • Fax:
Mailing address:
  • Phone: 626-623-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT41222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: