MEDICARE: SOLIS MEDICAL GROUP CA PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	103TH0100X	Health Service Psychologist
3	163WW0000X	Wound Care Registered Nurse
4	207N00000X	Dermatology Physician
5	2084H0002X	Hospice and Palliative Medicine (Psychiatry & Neurology) Physician
6	2084P0805X	Geriatric Psychiatry Physician
7	208VP0000X	Pain Medicine Physician
8	363LA2100X	Acute Care Nurse Practitioner
9	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1902691660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLIS MEDICAL GROUP CA PC

Provider Business Mailing Address
First Line	:	6659 SCHAEFER RD STE 155
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-1812
Country	:	US
Telephone Number	:	833-869-1532
Fax Number	:	833-869-1553

Provider Business Practice Location Address
First Line	:	341 EVIAN WAY
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-9261
Country	:	US
Telephone Number	:	833-869-1532
Fax Number	:	833-869-1553

Authorized Official
Title or Position	:	CONSULTANT
Name	:	PHOEBE GUTIERREZ
Credential	:
Telephone Number	:	916-826-4269

Provider Enumeration Date	:	04/14/2025
Last Update Date	:	05/21/2025

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Directions to “SOLIS MEDICAL GROUP CA PC ” Practice Location

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