Healthcare Provider Details

I. General information

NPI: 1831654466
Provider Name (Legal Business Name): MARTINA DAHL SOLIS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 TOWNER AVE NE STE A
ALBUQUERQUE NM
87110-3910
US

IV. Provider business mailing address

4414 TOWNER AVE NE STE A
ALBUQUERQUE NM
87110-3910
US

V. Phone/Fax

Practice location:
  • Phone: 505-507-4480
  • Fax:
Mailing address:
  • Phone: 505-507-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT9059
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: