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General NPI Number Information
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NPI Number | 1356561682
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Entity Type | Organization
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Legal Business Name | SOLANO DERMATOLOGY ASSOCIATES INC
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 600 NUT TREE RD SUITE 260
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City | VACAVILLE
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State | CA
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Zip | 95687-4669
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Country | US
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Telephone | 707-452-7222
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Fax | 707-452-8507
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Provider Business Mailing Address
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Address Line | 2290 SACRAMENTO ST
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City | VALLEJO
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State | CA
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Zip | 94590-2929
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Country | US
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Telephone | 707-643-5785
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Fax | 707-643-5876
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MS. SANDIE FOWLER
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Credential |
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Telephone | 707-556-5991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 019731
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License Number State | CA
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