Healthcare Provider Details

I. General information

NPI: 1215033477
Provider Name (Legal Business Name): AMY BETH SOLOMON ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 LA JOLLA VILLAGE DR
SAN DIEGO CA
92161-0002
US

IV. Provider business mailing address

1907 ESTRELLA DE MAR CT APT D
CARLSBAD CA
92009-6125
US

V. Phone/Fax

Practice location:
  • Phone: 858-642-3601
  • Fax:
Mailing address:
  • Phone: 858-642-3601
  • Fax: 858-552-7485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number12378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: