Provider Demographics
NPI:1508405531
Name:REYES SOLORIO, ANDREA GUADALUPE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:GUADALUPE
Last Name:REYES SOLORIO
Suffix:
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 1:2233 84TH AVE APT B
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-3490
Mailing Address - Country:US
Mailing Address - Phone:510-878-0954
Mailing Address - Fax:
Practice Address - Street 1:2233 84TH AVE APT B
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-3490
Practice Address - Country:US
Practice Address - Phone:510-878-0954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
0123OtherN/A