Provider Demographics
NPI:1346593373
Name:TABB, SOLOMON JR
Entity Type:Individual
Prefix:MR
First Name:SOLOMON
Middle Name:
Last Name:TABB
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4217
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94540-4217
Mailing Address - Country:US
Mailing Address - Phone:510-582-2100
Mailing Address - Fax:
Practice Address - Street 1:2251 PALM AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1814
Practice Address - Country:US
Practice Address - Phone:650-513-6504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410003AN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst