Healthcare Provider Details

I. General information

NPI: 1013167519
Provider Name (Legal Business Name): PETER ANTHONY SOLAN OTC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHRADER ST SUITE 650
SAN FRANCISCO CA
94117-1016
US

IV. Provider business mailing address

1 SHRADER ST SUITE 650
SAN FRANCISCO CA
94117-1016
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-0665
  • Fax: 415-221-0687
Mailing address:
  • Phone: 415-221-0665
  • Fax: 415-221-0687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number92-0487
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: