Provider Demographics
NPI:1366007767
Name:SOLIS, JONATHAN MARTIN
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MARTIN
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 1:11057 BASYE ST
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-1655
Mailing Address - Country:US
Mailing Address - Phone:626-444-0539
Mailing Address - Fax:
Practice Address - Street 1:11057 BASYE ST
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1655
Practice Address - Country:US
Practice Address - Phone:626-444-0539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor