Healthcare Provider Details

I. General information

NPI: 1922052729
Provider Name (Legal Business Name): SOLANO DERMATOLOGY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 SACRAMENTO ST
VALLEJO CA
94590-2929
US

IV. Provider business mailing address

2290 SACRAMENTO ST
VALLEJO CA
94590-2929
US

V. Phone/Fax

Practice location:
  • Phone: 707-643-5785
  • Fax: 707-643-8810
Mailing address:
  • Phone: 707-643-5785
  • Fax: 707-643-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN KEVIN GEISSE
Title or Position: OWNER
Credential: M.D.
Phone: 707-643-5785