MEDICARE: MISS MAYRA YALOHA SOLANO M.P.T.

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
1	225100000X	Physical Therapist	41220	CA

General Provider Information

NPI Number	:	1255758744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MAYRA YALOHA SOLANO M.P.T.

Provider Business Mailing Address
First Line	:	18102 IRVINE BLVD STE 207
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-3424
Country	:	US
Telephone Number	:	714-505-2966
Fax Number	:

Provider Business Practice Location Address
First Line	:	18102 IRVINE BLVD STE 207
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-3424
Country	:	US
Telephone Number	:	714-505-2966
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2014
Last Update Date	:	03/24/2014

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