Provider Demographics
NPI:1972754513
Name:CHAN, SOLIDA (STUDENT)
Entity Type:Individual
Prefix:
First Name:SOLIDA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1782 MINAS DE ORO
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1354
Mailing Address - Country:US
Mailing Address - Phone:408-259-7560
Mailing Address - Fax:
Practice Address - Street 1:160 E VIRGINIA ST STE 280
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5817
Practice Address - Country:US
Practice Address - Phone:408-287-6200
Practice Address - Fax:408-998-1535
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health