=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124066014
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLORIA SOLANO RN CNS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2006
-----------------------------------------------------
Last Update Date | 01/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9850 GENESEE AVE SUITE 970
-----------------------------------------------------
City | LA JOLLA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92037-1234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-558-2731
-----------------------------------------------------
Fax | 858-452-5905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 609001
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92160-9001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-528-4600
-----------------------------------------------------
Fax | 619-528-4625
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN505704
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 364SP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | CNS1710
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------