Healthcare Provider Details

I. General information

NPI: 1811176605
Provider Name (Legal Business Name): MARIE VALENTINE SOLLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD # UHN80
PORTLAND OR
97239-3098
US

IV. Provider business mailing address

16110 SW REGATTA LN
BEAVERTON OR
97006-8942
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-9671
  • Fax: 503-346-8219
Mailing address:
  • Phone: 503-690-3527
  • Fax: 503-536-6660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA101735
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD152593
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: