Provider Demographics
NPI:1053129163
Name:SOLIS, EDUARDO (PPS)
Entity type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:
Last Name:SOLIS
Suffix:
Gender:M
Credentials:PPS
Other - Prefix:MR
Other - First Name:EDUARDO
Other - Middle Name:
Other - Last Name:SOLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PPS
Mailing Address - Street 1:31001 RATTLER RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2702
Mailing Address - Country:US
Mailing Address - Phone:760-202-6455
Mailing Address - Fax:
Practice Address - Street 1:31001 RATTLER RD
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2702
Practice Address - Country:US
Practice Address - Phone:760-202-6455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool