Provider Demographics
NPI:1821814575
Name:SOLDANO, TIA
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:SOLDANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:
Other - Last Name:WOLFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3244 CASCADES TRL SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3659
Mailing Address - Country:US
Mailing Address - Phone:602-502-9275
Mailing Address - Fax:
Practice Address - Street 1:69 W. LOVE RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85143
Practice Address - Country:US
Practice Address - Phone:602-502-9275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician