=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447387600
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARY ALLEN SOLAK M.A.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2425 BISSO LN SUITE 235
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94520-4897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-646-5237
-----------------------------------------------------
Fax | 925-646-5810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 195 HARTFORD ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94114-2554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-961-2615
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC18618
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------