Provider Demographics
NPI:1538575840
Name:SOLANO, EDWIN
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:SOLANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 E MAIN ST FL 3
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-2748
Mailing Address - Country:US
Mailing Address - Phone:805-933-8480
Mailing Address - Fax:805-933-2614
Practice Address - Street 1:725 E MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2748
Practice Address - Country:US
Practice Address - Phone:805-933-8480
Practice Address - Fax:805-933-2614
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2021-07-08
Deactivation Date:2018-02-14
Deactivation Code:
Reactivation Date:2018-02-19
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
CALMFT126012106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)