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General NPI Number Information
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NPI Number | 1710347349
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Entity Type | Organization
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Legal Business Name | SOLSTICE MEDICINE & WELLNESS, LLC
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Dates
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Enumeration Date | 02/24/2016
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 475 RIVERSTONE WAY STE 2
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City | FAIRBANKS
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State | AK
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Zip | 99709-2971
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Country | US
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Telephone | 907-456-6334
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Fax | 907-456-6336
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Provider Business Mailing Address
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Address Line | 3875 GEIST RD STE E154
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City | FAIRBANKS
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State | AK
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Zip | 99709-3564
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Country | US
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Telephone | 907-456-6334
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Fax | 907-456-6336
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Authorized Official
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Title or Position | OWNER
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Name | GINA ESCOBAR
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Credential | MD
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Telephone | 907-978-5733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 1032552
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License Number State | AK
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