Healthcare Provider Details

I. General information

NPI: 1760492987
Provider Name (Legal Business Name): VICKI SOLONIUK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 JOHN JONES RD
DAVIS CA
95616
US

IV. Provider business mailing address

2051 JOHN JONES RD
DAVIS CA
95616-9701
US

V. Phone/Fax

Practice location:
  • Phone: 530-758-2060
  • Fax:
Mailing address:
  • Phone: 530-758-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG43766
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberG43766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: