Provider Demographics
NPI:1417551078
Name:SOLIS, VICTORIANO JR (CT)
Entity Type:Individual
Prefix:MR
First Name:VICTORIANO
Middle Name:
Last Name:SOLIS
Suffix:JR
Gender:M
Credentials:CT
Other - Prefix:MR
Other - First Name:VICTOR
Other - Middle Name:
Other - Last Name:SOLIS
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6000 KANAKANAK RD
Mailing Address - Street 2:
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576
Mailing Address - Country:US
Mailing Address - Phone:907-843-5266
Mailing Address - Fax:907-842-5915
Practice Address - Street 1:6000 KANAKANAK RD
Practice Address - Street 2:
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576
Practice Address - Country:US
Practice Address - Phone:907-843-5266
Practice Address - Fax:907-842-5915
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4317101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)