Provider Demographics
NPI:1275106502
Name:SOLOMON MEDICAL INC
Entity Type:Organization
Organization Name:SOLOMON MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:AWERBUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-373-3716
Mailing Address - Street 1:1120 FOREST AVE # 138
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-5105
Mailing Address - Country:US
Mailing Address - Phone:831-402-8728
Mailing Address - Fax:
Practice Address - Street 1:1501 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4110
Practice Address - Country:US
Practice Address - Phone:831-402-8728
Practice Address - Fax:831-372-8929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA131930OtherSTATE LICENSE