Provider Demographics
NPI:1922727742
Name:SOLIS SALAMANCA, DANIELLE LYNN
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LYNN
Last Name:SOLIS SALAMANCA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:LYNN
Other - Last Name:WEDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12736 OSBORNE ST
Mailing Address - Street 2:
Mailing Address - City:BORON
Mailing Address - State:CA
Mailing Address - Zip Code:93516-1843
Mailing Address - Country:US
Mailing Address - Phone:661-429-9006
Mailing Address - Fax:
Practice Address - Street 1:12736 OSBORNE ST
Practice Address - Street 2:
Practice Address - City:BORON
Practice Address - State:CA
Practice Address - Zip Code:93516-1843
Practice Address - Country:US
Practice Address - Phone:661-429-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB7408481172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty