Healthcare Provider Details

I. General information

NPI: 1912673039
Provider Name (Legal Business Name): REBECCA MARIE SOLOMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 09/30/2023
Certification Date: 09/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6810 N MILBURN AVE
FRESNO CA
93722-2155
US

IV. Provider business mailing address

1337 E THOMPSON AVE
TULARE CA
93274-7379
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-4227
  • Fax:
Mailing address:
  • Phone: 559-759-2218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: