Basic Information
| Provider Information | |||||||||
| NPI: | 1609094945 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOLANO | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | CHRISTIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 954 W FOOTHILL BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917863782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132589206 | ||||||||
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| Practice Location | |||||||||
| Address1: | 954 W FOOTHILL BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917863782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099464222 | ||||||||
| FaxNumber: | 9099468243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 08/30/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | PT 32927 | CA | N | Nursing Service Providers | Licensed Psychiatric Technician | 363LP0808X | 95012580 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.