Healthcare Provider Details

I. General information

NPI: 1710658422
Provider Name (Legal Business Name): V SOLANO MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 KIPLING ST
WHEAT RIDGE CO
80033-6762
US

IV. Provider business mailing address

996 JOLIET ST
AURORA CO
80010-4046
US

V. Phone/Fax

Practice location:
  • Phone: 303-456-4882
  • Fax:
Mailing address:
  • Phone: 303-903-7159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW V SOLANO
Title or Position: SURROGATE
Credential:
Phone: 303-903-7159