Healthcare Provider Details

I. General information

NPI: 1518194562
Provider Name (Legal Business Name): STACIE ALLISON SOLT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 39TH AVE
SAN MATEO CA
94403-4364
US

IV. Provider business mailing address

614 CREEK DR
MENLO PARK CA
94025-5315
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-2671
  • Fax:
Mailing address:
  • Phone: 415-260-6676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberA116975
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA116975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: