Provider Demographics
NPI:1871167825
Name:SOLANO, INGRID ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:INGRID
Middle Name:ANN
Last Name:SOLANO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90078-0401
Mailing Address - Country:US
Mailing Address - Phone:212-375-6668
Mailing Address - Fax:
Practice Address - Street 1:1041 N FORMOSA AVE
Practice Address - Street 2:WRITERS BUILDING #310
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5468
Practice Address - Country:US
Practice Address - Phone:212-375-6668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32592103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty