Provider Demographics
NPI:1073493078
Name:SOLARES, GEORGINA HORTENCIA (LMT)
Entity type:Individual
Prefix:MS
First Name:GEORGINA
Middle Name:HORTENCIA
Last Name:SOLARES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11715 ANTWERP AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-1822
Mailing Address - Country:US
Mailing Address - Phone:323-975-7964
Mailing Address - Fax:
Practice Address - Street 1:11715 ANTWERP AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-1822
Practice Address - Country:US
Practice Address - Phone:323-975-7964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96106225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist