1881681211 NPI number — MRS. WANDA SOLIS MD

Table of content: MRS. WANDA SOLIS MD (NPI 1881681211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881681211 NPI number — MRS. WANDA SOLIS MD

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOLIS
Provider Other First Name:
WANDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1881681211
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 W EMBERCREST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76017-6064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-331-0567
Provider Business Mailing Address Fax Number:
214-377-7779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4201 INTERWAY PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76018-5668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-652-8994
Provider Business Practice Location Address Fax Number:
817-652-3011
Provider Enumeration Date:
09/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  L3135 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 145757401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145757402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60121620 . This is a "DPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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