Provider Demographics
NPI:1083832166
Name:SOLOMON, JOETTA LYNN (RNP)
Entity Type:Individual
Prefix:MS
First Name:JOETTA
Middle Name:LYNN
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8151 ARLINGTON AVE
Mailing Address - Street 2:SUITES U-V
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-0436
Mailing Address - Country:US
Mailing Address - Phone:951-588-0861
Mailing Address - Fax:951-588-1910
Practice Address - Street 1:7117 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2658
Practice Address - Country:US
Practice Address - Phone:951-683-6370
Practice Address - Fax:951-784-3269
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31887ZOtherGROUP PTAN
CAEAP70324FOtherEAPC
CAHAP71040FMedicaid
CAEAP70324FOtherEAPC
CAHAP71040FMedicaid