1508841024 NPI number — DR. RONALD SOLOMON MD

Table of content: DR. RONALD SOLOMON MD (NPI 1508841024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508841024 NPI number — DR. RONALD SOLOMON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOLOMON
Provider First Name:
RONALD
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508841024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 AVOCADO AVE
Provider Second Line Business Mailing Address:
#608
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-640-2081
Provider Business Mailing Address Fax Number:
949-640-1909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 AVOCADO AVE
Provider Second Line Business Practice Location Address:
#608
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-640-2081
Provider Business Practice Location Address Fax Number:
949-640-1909
Provider Enumeration Date:
12/07/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G57132 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)