Healthcare Provider Details

I. General information

NPI: 1265612097
Provider Name (Legal Business Name): SOLO CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1864 DOWNINGTON AVE
SALT LAKE CITY UT
84108-2912
US

IV. Provider business mailing address

PO BOX 328
RIVERTON UT
84065-0328
US

V. Phone/Fax

Practice location:
  • Phone: 801-979-5330
  • Fax: 801-487-2703
Mailing address:
  • Phone: 801-979-5330
  • Fax: 801-487-2703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1966054405
License Number StateUT

VIII. Authorized Official

Name: MS. BENNETT NAVARRO
Title or Position: OWNER
Credential: APRN , NP
Phone: 801-979-5330