=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669700662
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOL CASE MANAGEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2009
-----------------------------------------------------
Last Update Date | 12/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 S. 3RD AVE.
-----------------------------------------------------
City | PASCO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-542-8890
-----------------------------------------------------
Fax | 866-204-7309
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 690
-----------------------------------------------------
City | PASCO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-542-8890
-----------------------------------------------------
Fax | 866-204-7309
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. ROLANDO RODRIGUEZ
-----------------------------------------------------
Credential | C.D.M.S.
-----------------------------------------------------
Telephone | 509-542-8890
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC2200X
-----------------------------------------------------
Taxonomy Name | Clinical Child & Adolescent Psychologist
-----------------------------------------------------
License Number | PY00003590
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PY00003590
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------