Healthcare Provider Details

I. General information

NPI: 1194103796
Provider Name (Legal Business Name): SOLANO CENTER OF EXCELLENCE MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 TUOLUMNE ST
VALLEJO CA
94589-2619
US

IV. Provider business mailing address

100 HOSPITAL DR STE 110
VALLEJO CA
94589-2577
US

V. Phone/Fax

Practice location:
  • Phone: 707-551-3360
  • Fax: 707-643-3018
Mailing address:
  • Phone: 707-551-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAYNITA ATALIG
Title or Position: PRACTICE MANAGER
Credential:
Phone: 707-551-3319