Healthcare Provider Details

I. General information

NPI: 1801669924
Provider Name (Legal Business Name): SOLACE HEALTH MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WARREN ST STE 300
REDWOOD CITY CA
94063-1536
US

IV. Provider business mailing address

401 WARREN ST STE 300
REDWOOD CITY CA
94063-1536
US

V. Phone/Fax

Practice location:
  • Phone: 708-320-1477
  • Fax: 207-881-4056
Mailing address:
  • Phone: 240-693-3281
  • Fax: 207-881-4056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JEREMY GUREWITZ
Title or Position: PRESIDENT
Credential:
Phone: 240-693-3281