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General NPI Number Information
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NPI Number | 1346408390
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Entity Type | Individual
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Provider Name | MARY SIDWELL SOLOMON R.D.
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Gender | Female
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 3605 EXECUTIVE DR
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City | SAN ANGELO
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State | TX
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Zip | 76904-6884
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Country | US
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Telephone | 325-224-5229
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Fax | 325-224-5901
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Provider Business Mailing Address
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Address Line | 1306 S MONROE ST
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City | SAN ANGELO
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State | TX
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Zip | 76901-4420
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Country | US
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Telephone | 325-763-8979
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Fax | 325-947-6852
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | DT01529
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License Number State | TX
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