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General NPI Number Information
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NPI Number | 1962639583
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Entity Type | Organization
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Legal Business Name | SOLANO DERMATOLOGY ASSOCIATES INC
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 06/22/2009
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Provider Practice Location Address
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Address Line | 6431 FAIRMOUNT AVE SUITE 3
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City | EL CERRITO
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State | CA
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Zip | 94530-3655
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Country | US
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Telephone | 510-527-8865
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Fax | 510-527-4123
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Provider Business Mailing Address
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Address Line | 2290 SACRAMENTO ST
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City | VALLEJO
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State | CA
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Zip | 94590-2929
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Country | US
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Telephone | 707-643-5785
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Fax | 707-643-8190
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Authorized Official
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Title or Position | OWNER
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Name | JOHN KEVIN GEISSE
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Credential | M.D.
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Telephone | 707-643-5785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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