Provider Demographics
NPI:1619003159
Name:SOLORZANO-MORENO, THERESA EDITH
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:EDITH
Last Name:SOLORZANO-MORENO
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 1:4882 FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2822
Mailing Address - Country:US
Mailing Address - Phone:805-729-1397
Mailing Address - Fax:
Practice Address - Street 1:4400 CATHEDRAL OAKS RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1042
Practice Address - Country:US
Practice Address - Phone:805-964-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29421041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool