Healthcare Provider Details

I. General information

NPI: 1043321870
Provider Name (Legal Business Name): LEE HOWARD SOLOW PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 HELIOTROPE AVE
CORONA DEL MAR CA
92625-2221
US

IV. Provider business mailing address

702 HELIOTROPE AVE
CORONA DEL MAR CA
92625-2221
US

V. Phone/Fax

Practice location:
  • Phone: 949-632-5464
  • Fax:
Mailing address:
  • Phone: 949-632-5464
  • Fax: 949-476-7035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY7104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: