MEDICARE: MR. MARCELL K SOLOMON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1033456108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCELL K SOLOMON

Provider Business Mailing Address
First Line	:	4431 S EASTERN AVE
Second Line	:	SUITE 1
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7850
Country	:	US
Telephone Number	:	702-750-0377
Fax Number	:	702-538-7928

Provider Business Practice Location Address
First Line	:	4431 S EASTERN AVE
Second Line	:	SUITE 1
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7850
Country	:	US
Telephone Number	:	702-750-0377
Fax Number	:	702-538-7928

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2013
Last Update Date	:	01/09/2013

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Directions to “ MR. MARCELL K SOLOMON ” Practice Location

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