Provider Demographics
NPI:1023508538
Name:SOLIS, MELISSA (LAC, DACM)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SOLIS
Suffix:
Gender:F
Credentials:LAC, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 PIER AVE STE B
Mailing Address - Street 2:#327
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3949
Mailing Address - Country:US
Mailing Address - Phone:310-779-1563
Mailing Address - Fax:
Practice Address - Street 1:727 2ND STREET
Practice Address - Street 2:#107
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254
Practice Address - Country:US
Practice Address - Phone:310-779-1563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17671171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist