Provider Demographics
NPI:1013752872
Name:CAMARILLO SOLFEST, TIMOTHY WILLIAM
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:WILLIAM
Last Name:CAMARILLO SOLFEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SERENITY CIR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-9031
Mailing Address - Country:US
Mailing Address - Phone:512-632-9333
Mailing Address - Fax:
Practice Address - Street 1:1995 BILLY MITCHELL BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-5625
Practice Address - Country:US
Practice Address - Phone:512-632-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1002323163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse