Healthcare Provider Details

I. General information

NPI: 1043928724
Provider Name (Legal Business Name): SOLOMON MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 FRUITDALE AVE
SAN JOSE CA
95128-2709
US

IV. Provider business mailing address

1120 FOREST AVE # 138
PACIFIC GROVE CA
93950-5105
US

V. Phone/Fax

Practice location:
  • Phone: 408-998-8447
  • Fax: 408-288-9812
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW JOEL AWERBUCK
Title or Position: OWNER
Credential: MD
Phone: 408-401-2581