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General NPI Number Information
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NPI Number | 1427202829
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Entity Type | Organization
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Legal Business Name | AMY SOLOMON MD A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/12/2008
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Last Update Date | 01/30/2009
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Provider Practice Location Address
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Address Line | 231 MAIN ST #A
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City | BEN LOMOND
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State | CA
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Zip | 95005-9394
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Country | US
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Telephone | 831-336-1300
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Fax | 831-336-1301
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Provider Business Mailing Address
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Address Line | 231-A MAIN ST.
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City | BEN LOMOND
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State | CA
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Zip | 95005-9394
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Country | US
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Telephone | 831-336-1300
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Fax | 831-336-1301
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Authorized Official
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Title or Position | LEAD PHYSICIAN / OWNER
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Name | DR. AMY BERKE SOLOMON
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Credential | MD
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Telephone | 831-336-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G80644
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License Number State | CA
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