Provider Demographics
NPI:1891451332
Name:SOLORZANO, IXCHEL CAROLINA (MA)
Entity Type:Individual
Prefix:
First Name:IXCHEL
Middle Name:CAROLINA
Last Name:SOLORZANO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2952 WORDEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5708
Mailing Address - Country:US
Mailing Address - Phone:408-529-9784
Mailing Address - Fax:
Practice Address - Street 1:7734 HERSCHEL AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4433
Practice Address - Country:US
Practice Address - Phone:858-568-7803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128774106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA128774OtherPRIVATE PRACTICE EMPLOYEE