Healthcare Provider Details

I. General information

NPI: 1205946365
Provider Name (Legal Business Name): SOLMAZ N/A MODEER RT, RTM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 3RD AVE STE G
CHULA VISTA CA
91911-5884
US

IV. Provider business mailing address

14795 CAMINITO ORENSE ESTE
SAN DIEGO CA
92129-1532
US

V. Phone/Fax

Practice location:
  • Phone: 619-409-6939
  • Fax: 619-409-6949
Mailing address:
  • Phone: 619-409-6939
  • Fax: 619-409-6949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471M2300X
TaxonomyMammography Radiologic Technologist
License NumberRHM61604
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: