Provider Demographics
NPI:1144243965
Name:SOLOMON, JEFFREY MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARK
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19632 VILLAGE OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6647
Mailing Address - Country:US
Mailing Address - Phone:714-337-0125
Mailing Address - Fax:
Practice Address - Street 1:19632 VILLAGE OAKS CIR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-6647
Practice Address - Country:US
Practice Address - Phone:714-337-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52837207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G528370Medicaid
CA00G528370385OtherCALOPTIMA ID #
CA050061874OtherRAILROAD MEDICARE ID #
CA00G528370OtherBLUE SHIELD ID #
CA00G528370Medicaid