Healthcare Provider Details

I. General information

NPI: 1285028209
Provider Name (Legal Business Name): SOLOMON CARE M.D., INC., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 ELM AVE SUITE 304
LONG BEACH CA
90813-3264
US

IV. Provider business mailing address

1040 ELM AVE SUITE 304
LONG BEACH CA
90813-3264
US

V. Phone/Fax

Practice location:
  • Phone: 562-624-1111
  • Fax: 562-624-1115
Mailing address:
  • Phone: 562-624-1111
  • Fax: 562-624-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SOLOMON LAKTINEH
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 562-624-1111