Basic Information
| Provider Information | |||||||||
| NPI: | 1538575840 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOLANO | ||||||||
| FirstName: | EDWIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 E MAIN ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | SANTA PAULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930602748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059338480 | ||||||||
| FaxNumber: | 8059332614 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 E MAIN ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | SANTA PAULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930602748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059338480 | ||||||||
| FaxNumber: | 8059332614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2014 | ||||||||
| LastUpdateDate: | 07/08/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 02/14/2018 | ||||||||
| NPIReactivationDate: | 02/19/2018 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | LMFT126012 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.