Provider Demographics
NPI:1184312696
Name:SOLIS, MAYRA ALEJANDRA (NP)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:ALEJANDRA
Last Name:SOLIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 748860
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374
Mailing Address - Country:US
Mailing Address - Phone:602-240-2401
Mailing Address - Fax:602-792-0244
Practice Address - Street 1:650 W MARYLAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1399
Practice Address - Country:US
Practice Address - Phone:602-240-2401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF04230252363LF0000X
AZ291592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily