Healthcare Provider Details

I. General information

NPI: 1215285200
Provider Name (Legal Business Name): SOL LIFE MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2012
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26700 TOWNE CENTRE DR SUITE 100
FOOTHILL RANCH CA
92610-2844
US

IV. Provider business mailing address

26700 TOWNE CENTRE DR SUITE 100
FOOTHILL RANCH CA
92610-2844
US

V. Phone/Fax

Practice location:
  • Phone: 949-460-9111
  • Fax: 949-460-9055
Mailing address:
  • Phone: 949-460-9111
  • Fax: 949-460-9055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberG77348
License Number StateCA

VIII. Authorized Official

Name: DR. SAMUEL SUNSHINE
Title or Position: PRESIDENT
Credential:
Phone: 949-460-9111