Healthcare Provider Details

I. General information

NPI: 1871664839
Provider Name (Legal Business Name): BARRY S. SOLOF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1889 W REDLANDS BLVD
REDLANDS CA
92373-3119
US

IV. Provider business mailing address

2095 N. INDIAN CANYON DR.
PALM SPRINGS CA
92262
US

V. Phone/Fax

Practice location:
  • Phone: 909-501-5167
  • Fax:
Mailing address:
  • Phone: 760-318-1012
  • Fax: 760-416-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberG29239
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberG29239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: