MEDICARE: BANA 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	251E00000X	Home Health Agency		CA

General Provider Information

NPI Number	:	1063879021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BANA SOLOMON

Provider Business Mailing Address
First Line	:	3742 HILLARY CT
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1589
Country	:	US
Telephone Number	:	510-935-0858
Fax Number	:

Provider Business Practice Location Address
First Line	:	3742 HILLARY CT
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1589
Country	:	US
Telephone Number	:	510-935-0858
Fax Number	:

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

Provider Enumeration Date	:	01/21/2016
Last Update Date	:	01/21/2016

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Directions to “ BANA SOLOMON ” Practice Location

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