Provider Demographics
NPI:1376010116
Name:SOLIS, JESSICA MCEWAN (OTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MCEWAN
Last Name:SOLIS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1726
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92684-1726
Mailing Address - Country:US
Mailing Address - Phone:714-750-9700
Mailing Address - Fax:714-750-9797
Practice Address - Street 1:12900B GARDEN GROVE BLVD STE 235
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2027
Practice Address - Country:US
Practice Address - Phone:714-750-9700
Practice Address - Fax:714-750-9797
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3272224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3272OtherOTA LICENSE