Healthcare Provider Details

I. General information

NPI: 1083832166
Provider Name (Legal Business Name): JOETTA LYNN SOLOMON RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2658
US

IV. Provider business mailing address

8151 ARLINGTON AVE SUITES U-V
RIVERSIDE CA
92503-0436
US

V. Phone/Fax

Practice location:
  • Phone: 951-683-6370
  • Fax: 951-784-3269
Mailing address:
  • Phone: 951-588-0861
  • Fax: 951-588-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: