Provider Demographics
NPI:1003831033
Name:SOLOMON, JASON HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:HARRIS
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:HARRIS
Other - Last Name:SOLOMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:959 RESERVE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678
Mailing Address - Country:US
Mailing Address - Phone:916-961-2083
Mailing Address - Fax:916-782-8662
Practice Address - Street 1:959 RESERVE DRIVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678
Practice Address - Country:US
Practice Address - Phone:916-961-2083
Practice Address - Fax:916-782-8662
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42591174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0G425910Medicaid
CAOG425910Medicare ID - Type Unspecified
CA0G425910Medicaid