=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801669924
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOLACE HEALTH MEDICAL GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2023
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 WARREN ST STE 300
-----------------------------------------------------
City | REDWOOD CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94063-1536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-320-1477
-----------------------------------------------------
Fax | 207-881-4056
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 WARREN ST STE 300
-----------------------------------------------------
City | REDWOOD CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94063-1536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-693-3281
-----------------------------------------------------
Fax | 207-881-4056
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JEREMY GUREWITZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-693-3281
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207QG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------