Provider Demographics
NPI:1265612097
Name:SOLO CLINICAL SERVICES LLC
Entity type:Organization
Organization Name:SOLO CLINICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN , NP
Authorized Official - Phone:801-979-5330
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-0328
Mailing Address - Country:US
Mailing Address - Phone:801-979-5330
Mailing Address - Fax:801-487-2703
Practice Address - Street 1:1864 DOWNINGTON AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2912
Practice Address - Country:US
Practice Address - Phone:801-979-5330
Practice Address - Fax:801-487-2703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1966054405363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS41780Medicare UPIN