Provider Demographics
NPI:1811363476
Name:SOLIS, ALFONSO JR
Entity type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:
Last Name:SOLIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 S 15TH AVE # APMT7D
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-2845
Mailing Address - Country:US
Mailing Address - Phone:928-446-5040
Mailing Address - Fax:
Practice Address - Street 1:750 S 15TH AVE # APMT7D
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2845
Practice Address - Country:US
Practice Address - Phone:928-446-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3832292385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child