MEDICARE: RORY SOLOMON I C.L.C.

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	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1295192474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RORY SOLOMON I C.L.C.

Provider Business Mailing Address
First Line	:	2282 ROUNDUP AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2842
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2282 ROUNDUP AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2842
Country	:	US
Telephone Number	:	610-209-8187
Fax Number	:

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

Provider Enumeration Date	:	01/20/2016
Last Update Date	:	01/20/2016

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