Provider Demographics
NPI:1184493645
Name:SOLACE MEDICAL CARE
Entity type:Organization
Organization Name:SOLACE MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:TUYET
Authorized Official - Middle Name:LAM
Authorized Official - Last Name:GWARDYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-760-2450
Mailing Address - Street 1:3119 N EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-7787
Mailing Address - Country:US
Mailing Address - Phone:562-760-2450
Mailing Address - Fax:
Practice Address - Street 1:111 SW 5TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-3604
Practice Address - Country:US
Practice Address - Phone:562-760-2450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty