Healthcare Provider Details

I. General information

NPI: 1780958165
Provider Name (Legal Business Name): GARY A SOLOMON, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
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:
Mailing address:
  • Phone: 562-424-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberC042316
License Number StateCA

VIII. Authorized Official

Name: DR. GARY ALAN SOLOMON
Title or Position: PRESIDENT
Credential: MD
Phone: 562-424-7787