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1356561682 NPI number — SOLANO DERMATOLOGY ASSOCIATES INC

NPI Number: 1356561682
Health Care Provider/Practitioner: SOLANO DERMATOLOGY ASSOCIATES INC

Information about “1356561682” NPI (SOLANO DERMATOLOGY ASSOCIATES INC) exists in 1356561682 in HTML format HTML  |  1356561682 in plain Text format TXT  |  1356561682 in PDF (Portable Document Format) PDF  |  1356561682 in an XML format XML  formats.

NPI Number : 1356561682 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1356561682",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SOLANO DERMATOLOGY ASSOCIATES INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2290 SACRAMENTO ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VALLEJO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94590-2929",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "707-643-5785",
    "MailingAddressFaxNumber": "707-643-5876",
    "FirstLinePracticeLocationAddress": "600 NUT TREE RD",
    "SecondLinePracticeLocationAddress": "SUITE 260",
    "PracticeLocationAddressCityName": "VACAVILLE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95687-4669",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "707-452-7222",
    "PracticeLocationAddressFaxNumber": "707-452-8507",
    "EnumerationDate": "04/27/2007",
    "LastUpdateDate": "04/12/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FOWLER",
    "AuthorizedOfficialFirstName": "SANDIE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CREDENTIALING SPECIALIST",
    "AuthorizedOfficialNamePrefix": "MS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "707-556-5991",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207N00000X",
        "TaxonomyName": "Dermatology Physician",
        "LicenseNumber": "019731",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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