Provider Demographics
NPI:1841742343
Name:SOLORZANO, ELIZABETH (RDA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SOLORZANO
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4364 CLARA ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-5091
Mailing Address - Country:US
Mailing Address - Phone:310-597-0499
Mailing Address - Fax:
Practice Address - Street 1:4364 CLARA ST APT 2
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-5091
Practice Address - Country:US
Practice Address - Phone:310-597-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA69248126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARDA69248Medicaid