Provider Demographics
NPI:1093262347
Name:SOLIS, JOSE DANIEL (CSFA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:DANIEL
Last Name:SOLIS
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 TRAVERS LN
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-5044
Mailing Address - Country:US
Mailing Address - Phone:386-479-3408
Mailing Address - Fax:
Practice Address - Street 1:1680 TRAVERS LN
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-5044
Practice Address - Country:US
Practice Address - Phone:386-479-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-03
Last Update Date:2016-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL168839246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant