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General NPI Number Information
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NPI Number | 1205325214
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Entity Type | Individual
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Provider Name | ERICK SOLERA PTA
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Gender | Male
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 05/04/2018
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Provider Practice Location Address
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Address Line | 6025 PINE AVE
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City | MAYWOOD
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State | CA
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Zip | 90270-3108
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Country | US
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Telephone | 323-560-0720
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Fax |
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Provider Business Mailing Address
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Address Line | 14416 WADKINS AVE
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City | GARDENA
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State | CA
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Zip | 90249-3151
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Country | US
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Telephone | 562-846-9393
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 49325
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License Number State | CA
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