1437787603 NPI number — SOLIS PSYCHOTHERAPY, A MARRIAGE & FAMILY THERAPY CORP.

Table of content: MARY ANNA GRAHAM LPN (NPI 1265835607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437787603 NPI number — SOLIS PSYCHOTHERAPY, A MARRIAGE & FAMILY THERAPY CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLIS PSYCHOTHERAPY, A MARRIAGE & FAMILY THERAPY CORP.
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:
Provider Other Organization Name Type Code:
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:
1437787603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5150 E PACIFIC COAST HWY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90804-3399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-999-2317
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5150 E PACIFIC COAST HWY STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90804-3399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-999-2317
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2020

Additional Information

Authorized Official

Authorized Official Last Name:
SOLIS
Authorized Official First Name:
ISCEL-CATTLEYA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
565-481-1821

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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