Provider Demographics
NPI:1114147923
Name:SOLIS, MARIO
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:SOLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S MAIN ST
Mailing Address - Street 2:BLDG B STE 20
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2917
Mailing Address - Country:US
Mailing Address - Phone:505-525-5635
Mailing Address - Fax:505-647-8804
Practice Address - Street 1:1100 S MAIN ST
Practice Address - Street 2:BLDG B STE 20
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2917
Practice Address - Country:US
Practice Address - Phone:505-525-5635
Practice Address - Fax:505-647-8804
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator