Healthcare Provider Details

I. General information

NPI: 1396729216
Provider Name (Legal Business Name): BRIAN D SOLBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S GRAND AVE SUITE 123
LOS ANGELES CA
90015-3067
US

IV. Provider business mailing address

1414 S GRAND AVE STE 210
LOS ANGELES CA
90015-3067
US

V. Phone/Fax

Practice location:
  • Phone: 213-455-8448
  • Fax: 213-745-8922
Mailing address:
  • Phone: 213-455-8448
  • Fax: 213-745-8922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG84376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: