Provider Demographics
NPI:1518657147
Name:SOLTERO, MARY TERESA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:TERESA
Last Name:SOLTERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:TERESA
Other - Last Name:SOLTERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:2133 W 84TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-2912
Mailing Address - Country:US
Mailing Address - Phone:310-686-6837
Mailing Address - Fax:
Practice Address - Street 1:2100 W 3RD ST STE 500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1922
Practice Address - Country:US
Practice Address - Phone:310-686-6837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014044363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily