Provider Demographics
NPI:1427354406
Name:SOLANO, LAURA (PA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SOLANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W. LAS COLINAS BLVD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:972-236-0096
Practice Address - Street 1:4200 SOUTH FWY
Practice Address - Street 2:SUITE 106
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-1400
Practice Address - Country:US
Practice Address - Phone:817-566-0505
Practice Address - Fax:817-566-0509
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06771363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB140283Medicare PIN