Basic Information
Provider Information
NPI: 1497174916
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SOLIS
FirstName: TRINIDAD
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2625 E DIVISADERO ST
Address2:  
City: FRESNO
State: CA
PostalCode: 937211431
CountryCode: US
TelephoneNumber: 5594432682
FaxNumber: 5594432681
Practice Location
Address1: 290 N WAYTE LN STE 2100
Address2:  
City: FRESNO
State: CA
PostalCode: 937012124
CountryCode: US
TelephoneNumber: 8663426012
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/11/2014
LastUpdateDate: 05/03/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/03/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XA139050CAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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