Provider Demographics
NPI:1497936207
Name:BRIAN SOLOMON
Entity Type:Organization
Organization Name:BRIAN SOLOMON
Other - Org Name:MCBREE MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-757-1477
Mailing Address - Street 1:10503 S WESTERN AVE
Mailing Address - Street 2:A&D
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-4458
Mailing Address - Country:US
Mailing Address - Phone:323-757-1477
Mailing Address - Fax:323-757-1477
Practice Address - Street 1:10503 S WESTERN AVE
Practice Address - Street 2:A&D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-4458
Practice Address - Country:US
Practice Address - Phone:323-757-1477
Practice Address - Fax:323-757-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46258332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5980240001Medicare NSC