MEDICARE: MIL EUGENE SOLLANO FP

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1730302639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIL EUGENE SOLLANO FP

Provider Business Mailing Address
First Line	:	5745 W COMET AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-1309
Country	:	US
Telephone Number	:	623-842-5714
Fax Number	:

Provider Business Practice Location Address
First Line	:	5745 W COMET AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-1309
Country	:	US
Telephone Number	:	623-842-5714
Fax Number	:

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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