Healthcare Provider Details

I. General information

NPI: 1386727162
Provider Name (Legal Business Name): GARY A SOLOMON M.D., INC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 ATLANTIC AVE SUITE 210
LONG BEACH CA
90806-1714
US

IV. Provider business mailing address

2880 ATLANTIC AVE SUITE 210
LONG BEACH CA
90806-1714
US

V. Phone/Fax

Practice location:
  • Phone: 562-424-7787
  • Fax: 562-424-7758
Mailing address:
  • Phone: 562-424-7787
  • Fax: 562-424-7758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberC42316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: