Provider Demographics
NPI:1821329921
Name:SOLIS, MARIA AGNE (RDA)
Entity Type:Individual
Prefix:
First Name:MARIA AGNE
Middle Name:
Last Name:SOLIS
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5807 N. FIGUEROA ST.
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90042
Mailing Address - Country:US
Mailing Address - Phone:323-982-0999
Mailing Address - Fax:323-982-0350
Practice Address - Street 1:5807 N FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-4227
Practice Address - Country:US
Practice Address - Phone:323-982-0999
Practice Address - Fax:323-982-0350
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47765126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant