Individual
JACK E. SOULIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
931 BUENA VISTA ST STE 105, DUARTE, CA 91010-1780
(626) 256-1415
(626) 256-1405
Mailing address
931 BUENA VISTA ST STE 105, DUARTE, CA 91010-1780
(626) 256-1415
(626) 256-1405
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
CPO03980
—
224P00000X
Prosthetist
CPO03980
—
Other
Enumeration date
03/06/2018
Last updated
03/06/2018
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