MEDICARE: SOLANO DIAGNOSTICS PARTERNS, A CALIF PARTNERHSIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1780132928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLANO DIAGNOSTICS PARTERNS, A CALIF PARTNERHSIP

Provider Business Mailing Address
First Line	:	PO BOX 39000
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94139-0001
Country	:	US
Telephone Number	:	855-820-5256
Fax Number	:

Provider Business Practice Location Address
First Line	:	5206 SW SAVAGE ST
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-5277
Country	:	US
Telephone Number	:	707-646-4646
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	ELNORA CAMERON
Credential	:
Telephone Number	:	707-646-3288

Provider Enumeration Date	:	09/16/2016
Last Update Date	:	09/16/2016

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