1194992057 NPI number — MS. PAULETTE MAE SOLBERG MFT 23341

Table of content: MS. PAULETTE MAE SOLBERG MFT 23341 (NPI 1194992057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194992057 NPI number — MS. PAULETTE MAE SOLBERG MFT 23341

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOLBERG
Provider First Name:
PAULETTE
Provider Middle Name:
MAE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFT 23341
Provider Gender Code:
F

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:
1194992057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5240 JACKSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH HIGHLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95660-5003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-338-1001
Provider Business Mailing Address Fax Number:
916-338-1044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5240 JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HIGHLANDS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95660-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-338-1001
Provider Business Practice Location Address Fax Number:
916-338-1044
Provider Enumeration Date:
05/09/2008

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: 106H00000X , with the licence number:  MFC 23341 , 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)





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