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NPI Code Detail

MEDICARE: JEPH A SOLO RNFA

MEDICARE:   JEPH A SOLO  RNFA
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
1174400000XSpecialistCA577611CA

General Provider Information

NPI Number : 1306087747
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEPH A SOLO RNFA
Provider Business Mailing Address
First Line : PO BOX 978
Second Line :
City : COLUMBIA
State : CA
Zip : 95310-0978
Country : US
Telephone Number : 209-533-3838
Fax Number : 209-533-3838
Provider Business Practice Location Address
First Line : 11833 BAXTER QUARRY ROAD
Second Line :
City : COLUMBIA
State : CA
Zip : 95310-0978
Country : US
Telephone Number : 209-533-3838
Fax Number : 209-533-3838
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2009
Last Update Date : 03/16/2009

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