Provider Demographics
NPI:1366452260
Name:KROCHALIS-SOLIANI, ROBERT W (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:KROCHALIS-SOLIANI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:W
Other - Last Name:KROCHALIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:31581 CANYON ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-0424
Mailing Address - Country:US
Mailing Address - Phone:951-244-3500
Mailing Address - Fax:951-244-3535
Practice Address - Street 1:600 MAIN ST.
Practice Address - Street 2:
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960-2655
Practice Address - Country:US
Practice Address - Phone:831-678-2665
Practice Address - Fax:831-678-8411
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17484363A00000X
CAPA17484363AM0700X
TXPA14197363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA17484OtherLICENSE