Healthcare Provider Details

I. General information

NPI: 1649879537
Provider Name (Legal Business Name): DAVID MICHAEL SOLIANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLD 4101 STUART MESA ROAD
CAMP PENDLETON CA
92055-5584
US

IV. Provider business mailing address

168 HAMILTON ST
OCEANSIDE CA
92058-7720
US

V. Phone/Fax

Practice location:
  • Phone: 760-390-9244
  • Fax:
Mailing address:
  • Phone: 860-307-5538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number04204038DS
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: