Healthcare Provider Details

I. General information

NPI: 1841437308
Provider Name (Legal Business Name): BRIAN D SOLBERG MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S GRAND AVE STE 123
LOS ANGELES CA
90015-3071
US

IV. Provider business mailing address

1414 S GRAND AVE STE 123
LOS ANGELES CA
90015-3071
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 Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG84376
License Number StateCA

VIII. Authorized Official

Name: DR. BRIAN D SOLBERG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 213-455-8448