Provider Demographics
NPI:1093419012
Name:SOLIS RIVERA, ALICIA CONCEPCION
Entity Type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:CONCEPCION
Last Name:SOLIS RIVERA
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 1:9730 RESEDA BLVD APT 204
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-2077
Mailing Address - Country:US
Mailing Address - Phone:951-892-3061
Mailing Address - Fax:
Practice Address - Street 1:9730 RESEDA BLVD APT 204
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2077
Practice Address - Country:US
Practice Address - Phone:951-892-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker