Healthcare Provider Details

I. General information

NPI: 1447991203
Provider Name (Legal Business Name): JONAH SOLOMON DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: YONAH SOLOMON

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12675 LA MIRADA BLVD
LA MIRADA CA
90638-2200
US

IV. Provider business mailing address

12675 LA MIRADA BLVD
LA MIRADA CA
90638-2200
US

V. Phone/Fax

Practice location:
  • Phone: 562-967-2273
  • Fax: 562-967-2911
Mailing address:
  • Phone: 562-967-2273
  • Fax: 562-967-2911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95155000
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95029075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: