Provider Demographics
NPI:1306342209
Name:SOLIS, ODETTE KASSAR (MD)
Entity type:Individual
Prefix:DR
First Name:ODETTE
Middle Name:KASSAR
Last Name:SOLIS
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 1:9179 W THUNDERBIRD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4912
Mailing Address - Country:US
Mailing Address - Phone:202-213-8698
Mailing Address - Fax:
Practice Address - Street 1:9179 W THUNDERBIRD RD STE 101
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4912
Practice Address - Country:US
Practice Address - Phone:202-213-8698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-01
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ719262086X0206X
TN679812086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program