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NPI Code Detail

MEDICARE: JUAN SOLIS

MEDICARE:   JUAN  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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1134435977
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUAN SOLIS
Provider Business Mailing Address
First Line : 4603 HEARTS DESIRE AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89115-3508
Country : US
Telephone Number : 562-644-2046
Fax Number :
Provider Business Practice Location Address
First Line : 3450 W CHEYENNE AVE STE 400&500
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-8222
Country : US
Telephone Number : 702-631-0646
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2010
Last Update Date : 08/30/2010

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Directions to “ JUAN SOLIS ” Practice Location

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