Provider Demographics
NPI:1275189193
Name:SOLORIO, MELEANE
Entity Type:Individual
Prefix:
First Name:MELEANE
Middle Name:
Last Name:SOLORIO
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 1:9255 W RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1368
Mailing Address - Country:US
Mailing Address - Phone:619-512-6474
Mailing Address - Fax:
Practice Address - Street 1:6615 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3921
Practice Address - Country:US
Practice Address - Phone:702-722-6200
Practice Address - Fax:702-722-6202
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV251E00000XOtherHOME HEALTH