Healthcare Provider Details

I. General information

NPI: 1235182510
Provider Name (Legal Business Name): ROBERT S SOLOMON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 MAGNOLIA AVE SUITE 207
CORONA CA
92879-3104
US

IV. Provider business mailing address

802 MAGNOLIA AVE SUITE 207
CORONA CA
92879-3104
US

V. Phone/Fax

Practice location:
  • Phone: 714-437-7400
  • Fax: 714-437-7410
Mailing address:
  • Phone: 714-437-7400
  • Fax: 714-437-7410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY8356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: