Provider Demographics
NPI:1477788412
Name:SHAFTEL, SOLOMON (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SOLOMON
Middle Name:
Last Name:SHAFTEL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 F ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2625
Mailing Address - Country:US
Mailing Address - Phone:619-422-1471
Mailing Address - Fax:
Practice Address - Street 1:5893 COPLEY DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-7906
Practice Address - Country:US
Practice Address - Phone:586-165-4998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60333195207W00000X
CAA115035207W00000X
SD9580207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1477788412Medicaid
CA1477788412Medicaid
WA8918859Medicare PIN
CA8918859Medicare PIN