Healthcare Provider Details

I. General information

NPI: 1154306231
Provider Name (Legal Business Name): SOLARA MEDICAL SUPPLIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 HWY 75
IMPERIAL BEACH CA
91932
US

IV. Provider business mailing address

2084 OTAY LAKES RD STE 102
CHULA VISTA CA
91913-1368
US

V. Phone/Fax

Practice location:
  • Phone: 619-424-8143
  • Fax: 619-424-8652
Mailing address:
  • Phone: 800-999-7516
  • Fax: 800-999-7021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY46235
License Number StateCA

VIII. Authorized Official

Name: MR. TOD JEFFREY ROBINSON
Title or Position: PRESIDENT
Credential:
Phone: 858-259-8287