Provider Demographics
NPI:1699013177
Name:CHACAJ-SOLIS, MARISSA L
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:L
Last Name:CHACAJ-SOLIS
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 1:8915 SW COMMERCIAL ST UNIT 30
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6240
Mailing Address - Country:US
Mailing Address - Phone:971-201-7430
Mailing Address - Fax:
Practice Address - Street 1:2402 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3229
Practice Address - Country:US
Practice Address - Phone:360-241-6630
Practice Address - Fax:360-567-0620
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60190315225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist