MEDICARE: MS. NIJI JUSTIN SOLOMON FNP

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	363LF0000X	Family Nurse Practitioner	95011506	CA

General Provider Information

NPI Number	:	1912566456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NIJI JUSTIN SOLOMON FNP

Provider Business Mailing Address
First Line	:	2450 N HARBOR BLVD APT 12
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-2617
Country	:	US
Telephone Number	:	714-588-6443
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 N HARBOR BLVD APT 12
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-2617
Country	:	US
Telephone Number	:	714-588-6443
Fax Number	:

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

Provider Enumeration Date	:	06/09/2019
Last Update Date	:	06/09/2019

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