Provider Demographics
NPI:1518588235
Name:SOLIS SOLIS, CARMEN ROSA (PA)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ROSA
Last Name:SOLIS SOLIS
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1202 PRESTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-8713
Mailing Address - Country:US
Mailing Address - Phone:678-499-4331
Mailing Address - Fax:
Practice Address - Street 1:360 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5005
Practice Address - Country:US
Practice Address - Phone:678-499-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant