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NPI Code Detail

MEDICARE: MARIO SOLIS

MEDICARE: MARIO SOLIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1114147923
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIO SOLIS
Provider Business Mailing Address
First Line : 1100 S MAIN ST
Second Line : BLDG B STE 20
City : LAS CRUCES
State : NM
Zip : 88005-2917
Country : US
Telephone Number : 505-525-5635
Fax Number : 505-647-8804
Provider Business Practice Location Address
First Line : 1100 S MAIN ST
Second Line : BLDG B STE 20
City : LAS CRUCES
State : NM
Zip : 88005-2917
Country : US
Telephone Number : 505-525-5635
Fax Number : 505-647-8804
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2007
Last Update Date : 07/08/2007

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Directions to “ MARIO SOLIS ” Practice Location

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