Provider Demographics
NPI:1467078238
Name:SOLORZANO BRAVO, MARENA CLECINERI X
Entity Type:Individual
Prefix:
First Name:MARENA
Middle Name:CLECINERI
Last Name:SOLORZANO BRAVO
Suffix:X
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 1:4223 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-5006
Mailing Address - Country:US
Mailing Address - Phone:206-539-8882
Mailing Address - Fax:
Practice Address - Street 1:4223 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5006
Practice Address - Country:US
Practice Address - Phone:206-539-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service