Provider Demographics
NPI:1427202829
Name:AMY SOLOMON MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:AMY SOLOMON MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:BALANCE HEALTH OF BEN LOMOND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:BERKE
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-336-1300
Mailing Address - Street 1:231-A MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:BEN LOMOND
Mailing Address - State:CA
Mailing Address - Zip Code:95005-9394
Mailing Address - Country:US
Mailing Address - Phone:831-336-1300
Mailing Address - Fax:831-336-1301
Practice Address - Street 1:231 MAIN ST
Practice Address - Street 2:#A
Practice Address - City:BEN LOMOND
Practice Address - State:CA
Practice Address - Zip Code:95005-9394
Practice Address - Country:US
Practice Address - Phone:831-336-1300
Practice Address - Fax:831-336-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80644208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty