Healthcare Provider Details

I. General information

NPI: 1760916555
Provider Name (Legal Business Name): SOLARA HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5322 SOLEDAD MOUNTAIN RD
SAN DIEGO CA
92109-1531
US

IV. Provider business mailing address

809 EMERALD BAY
LAGUNA BEACH CA
92651-1228
US

V. Phone/Fax

Practice location:
  • Phone: 844-600-9747
  • Fax:
Mailing address:
  • Phone: 949-370-0771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DERIK BRIAN
Title or Position: CEO
Credential:
Phone: 949-370-0771