1417124983 NPI number — SOLIS INC.

Table of content: (NPI 1417124983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417124983 NPI number — SOLIS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLIS INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WORLD OPTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417124983
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 N STATE COLLEGE BLVD STE 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92806-2900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-776-3335
Provider Business Mailing Address Fax Number:
714-400-0127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 N STATE COLLEGE BLVD STE 208
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92806-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-776-3335
Provider Business Practice Location Address Fax Number:
714-400-0127
Provider Enumeration Date:
05/13/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FAVELA
Authorized Official First Name:
RAY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-776-3335

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  D7045 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)