1427202829 NPI number — AMY SOLOMON MD A PROFESSIONAL MEDICAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427202829 NPI number — AMY SOLOMON MD A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMY SOLOMON MD A PROFESSIONAL MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1427202829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
231-A MAIN ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEN LOMOND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95005-9394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-336-1300
Provider Business Mailing Address Fax Number:
831-336-1301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 MAIN ST
Provider Second Line Business Practice Location Address:
#A
Provider Business Practice Location Address City Name:
BEN LOMOND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95005-9394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-336-1300
Provider Business Practice Location Address Fax Number:
831-336-1301
Provider Enumeration Date:
11/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SOLOMON
Authorized Official First Name:
AMY
Authorized Official Middle Name:
BERKE
Authorized Official Title or Position:
LEAD PHYSICIAN / OWNER
Authorized Official Telephone Number:
831-336-1300

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  G80644 , 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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