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General NPI Number Information
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NPI Number | 1629006655
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Entity Type | Organization
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Legal Business Name | SOUTHERN SOLANO EMERGENCY MEDICAL GROUP, INC
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 300 HOSPITAL DR
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City | VALLEJO
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State | CA
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Zip | 94589-2574
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Country | US
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Telephone | 925-924-1600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 634719
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City | CINCINNATI
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State | OH
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Zip | 45263-4719
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD D CARVOLTH
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Credential | M.D.
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Telephone | 925-924-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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