Provider Demographics
NPI:1386630044
Name:SOLOMON, ALAN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:M
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 SKYPARK DR
Mailing Address - Street 2:STE 210
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5388
Mailing Address - Country:US
Mailing Address - Phone:310-539-2772
Mailing Address - Fax:
Practice Address - Street 1:2790 SKYPARK DR
Practice Address - Street 2:STE 210
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5388
Practice Address - Country:US
Practice Address - Phone:310-539-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6183103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY6183OtherBOARD OF PSYCHOLOGY
CAPSY6183OtherBOARD OF PSYCHOLOGY