Provider Demographics
NPI:1437317195
Name:JASON H. SOLOMON MD INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JASON H. SOLOMON MD INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:H
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-961-2083
Mailing Address - Street 1:6633 COYLE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6332
Mailing Address - Country:US
Mailing Address - Phone:916-961-2083
Mailing Address - Fax:916-961-7042
Practice Address - Street 1:6633 COYLE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6332
Practice Address - Country:US
Practice Address - Phone:916-961-2083
Practice Address - Fax:916-961-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42510174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G425100Medicaid
CA00G425100Medicaid
CA00G425100Medicare PIN