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General NPI Number Information
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NPI Number | 1568777126
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Entity Type | Organization
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Legal Business Name | SOLANO FAMILY PHYSICIANS MEDICAL GROUP PROF CORP
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Dates
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Enumeration Date | 08/06/2010
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Last Update Date | 12/29/2011
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Provider Practice Location Address
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Address Line | 1100 ROSE DR SUITE 140
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City | BENICIA
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State | CA
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Zip | 94510-3623
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Country | US
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Telephone | 707-745-2705
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Fax | 707-745-1902
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Provider Business Mailing Address
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Address Line | 1100 ROSE DR SUITE 140
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City | BENICIA
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State | CA
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Zip | 94510-3623
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Country | US
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Telephone | 707-745-2705
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. KENNETH R. BROOKS
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Credential | MD
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Telephone | 707-745-2705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 00A0627550
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License Number State | CA
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