Provider Demographics
NPI:1255758744
Name:SOLANO, MAYRA YALOHA (MPT)
Entity type:Individual
Prefix:MISS
First Name:MAYRA
Middle Name:YALOHA
Last Name:SOLANO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18102 IRVINE BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3424
Mailing Address - Country:US
Mailing Address - Phone:714-505-2966
Mailing Address - Fax:
Practice Address - Street 1:18102 IRVINE BLVD STE 207
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3424
Practice Address - Country:US
Practice Address - Phone:714-505-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist