Provider Demographics
NPI:1881681211
Name:SOLIS, WANDA (MD)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:
Last Name:SOLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:WANDA
Other - Middle Name:
Other - Last Name:SOLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:800 W EMBERCREST DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-6064
Mailing Address - Country:US
Mailing Address - Phone:214-331-0567
Mailing Address - Fax:214-377-7779
Practice Address - Street 1:4201 INTERWAY PL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-5668
Practice Address - Country:US
Practice Address - Phone:817-652-8994
Practice Address - Fax:817-652-3011
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3135208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145757401Medicaid
TX145757402Medicaid
TX60121620OtherDPS
TX60121620OtherDPS
TXAS2690849OtherDEA
D08792Medicare UPIN