Provider Demographics
NPI:1952392250
Name:SOLORIO-ARCIGA, WANDA MARIE (FNP,A)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:MARIE
Last Name:SOLORIO-ARCIGA
Suffix:
Gender:F
Credentials:FNP,A
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:MARIE
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4183 TAHAMA LN
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-8645
Mailing Address - Country:US
Mailing Address - Phone:209-262-5494
Mailing Address - Fax:
Practice Address - Street 1:1800 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6019
Practice Address - Country:US
Practice Address - Phone:209-467-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16176363A00000X
CANP12817363LF0000X
UT6560146-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA161760Medicaid
CAOPA161760Medicaid
D43200Medicare UPIN