Provider Demographics
NPI:1245811314
Name:SOLIS ALVAREZ, BIANCA ELIZABETH
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:ELIZABETH
Last Name:SOLIS ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 AIRPORT RD TRLR 28
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2853
Mailing Address - Country:US
Mailing Address - Phone:505-501-9874
Mailing Address - Fax:
Practice Address - Street 1:4001 OFFICE COURT DR STE 603
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4905
Practice Address - Country:US
Practice Address - Phone:505-310-4764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty