Provider Demographics
NPI:1578695037
Name:SOLANO, DIANA JANE ESPELINBERGO
Entity Type:Individual
Prefix:MS
First Name:DIANA JANE
Middle Name:ESPELINBERGO
Last Name:SOLANO
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 1:11211 NE 140TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-5318
Mailing Address - Country:US
Mailing Address - Phone:425-442-0442
Mailing Address - Fax:
Practice Address - Street 1:8862 161ST AVE NE STE 102
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7553
Practice Address - Country:US
Practice Address - Phone:425-883-9532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00067498183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician