Healthcare Provider Details

I. General information

NPI: 1538222401
Provider Name (Legal Business Name): DAVID SOLARTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 MOTT ST # 100110
SAN FERNANDO CA
91340-4237
US

IV. Provider business mailing address

732 MOTT ST # 100-110
SAN FERNANDO CA
91340-4237
US

V. Phone/Fax

Practice location:
  • Phone: 818-963-5690
  • Fax:
Mailing address:
  • Phone: 818-963-5690
  • Fax: 818-847-6339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA48255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: