Provider Demographics
NPI:1639990344
Name:SOLACE MOBILE IV PLLC
Entity type:Organization
Organization Name:SOLACE MOBILE IV PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:QUIJANO
Authorized Official - Last Name:PANGAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:702-526-6763
Mailing Address - Street 1:8899 LA MANGA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6022
Mailing Address - Country:US
Mailing Address - Phone:702-526-6763
Mailing Address - Fax:
Practice Address - Street 1:8899 LA MANGA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6022
Practice Address - Country:US
Practice Address - Phone:702-526-6763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty