Healthcare Provider Details

I. General information

NPI: 1033456108
Provider Name (Legal Business Name): MR. MARCELL K SOLOMON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4431 S EASTERN AVE SUITE 1
LAS VEGAS NV
89119-7850
US

IV. Provider business mailing address

4431 S EASTERN AVE SUITE 1
LAS VEGAS NV
89119-7850
US

V. Phone/Fax

Practice location:
  • Phone: 702-750-0377
  • Fax: 702-538-7928
Mailing address:
  • Phone: 702-750-0377
  • Fax: 702-538-7928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: