Healthcare Provider Details

I. General information

NPI: 1417062340
Provider Name (Legal Business Name): DAVID J SOLIS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E MOCKINGBIRD LN SUITE 220
VICTORIA TX
77904-2155
US

IV. Provider business mailing address

PO BOX 4897
HOUSTON TX
77210-4897
US

V. Phone/Fax

Practice location:
  • Phone: 361-573-6291
  • Fax: 361-576-2434
Mailing address:
  • Phone: 903-787-5850
  • Fax: 903-787-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number634529
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: