Provider Demographics
NPI:1083387161
Name:SOLORIO VARGAS, AZALIA L
Entity Type:Individual
Prefix:
First Name:AZALIA
Middle Name:L
Last Name:SOLORIO VARGAS
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 1:210 E FIR ST
Mailing Address - Street 2:
Mailing Address - City:OTHELLO
Mailing Address - State:WA
Mailing Address - Zip Code:99344-1030
Mailing Address - Country:US
Mailing Address - Phone:509-707-9430
Mailing Address - Fax:
Practice Address - Street 1:210 E FIR ST
Practice Address - Street 2:
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344-1030
Practice Address - Country:US
Practice Address - Phone:509-707-9430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC54048171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty