Healthcare Provider Details

I. General information

NPI: 1336721570
Provider Name (Legal Business Name): LESLIE MARIE SOLIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 L DON DODSON DR STE 110
BEDFORD TX
76021-1844
US

IV. Provider business mailing address

2008 L DON DODSON DR STE 110
BEDFORD TX
76021-1844
US

V. Phone/Fax

Practice location:
  • Phone: 817-283-0967
  • Fax:
Mailing address:
  • Phone: 817-283-0967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA14402
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: