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General NPI Number Information
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NPI Number | 1184493645
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Entity Type | Organization
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Legal Business Name | SOLACE MEDICAL CARE
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Dates
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Enumeration Date | 12/26/2023
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Last Update Date | 12/26/2023
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Provider Practice Location Address
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Address Line | 111 SW 5TH AVE
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City | PORTLAND
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State | OR
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Zip | 97204-3604
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Country | US
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Telephone | 562-760-2450
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Fax |
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Provider Business Mailing Address
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Address Line | 3119 N EVERGREEN ST
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City | BUCKEYE
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State | AZ
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Zip | 85396-7787
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Country | US
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Telephone | 562-760-2450
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | TUYET LAM GWARDYS
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Credential |
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Telephone | 562-760-2450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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