Provider Demographics
NPI:1083254601
Name:SOLANO GONZALEZ, DALIA
Entity Type:Individual
Prefix:DR
First Name:DALIA
Middle Name:
Last Name:SOLANO GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 W CAMILLE ST APT A
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7807
Mailing Address - Country:US
Mailing Address - Phone:714-603-0717
Mailing Address - Fax:
Practice Address - Street 1:3714 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3409
Practice Address - Country:US
Practice Address - Phone:714-603-0717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104690122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist