Provider Demographics
NPI:1215987409
Name:SOLONIUK-TAYS, GAYLENE (MD)
Entity type:Individual
Prefix:DR
First Name:GAYLENE
Middle Name:
Last Name:SOLONIUK-TAYS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 N CONYER ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4704
Mailing Address - Country:US
Mailing Address - Phone:559-713-1101
Mailing Address - Fax:559-713-1121
Practice Address - Street 1:306 N CONYER ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4704
Practice Address - Country:US
Practice Address - Phone:559-713-1101
Practice Address - Fax:559-713-1121
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A420930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A420930Medicaid
CAA29504Medicare UPIN
CA00A420930Medicaid