Provider Demographics
NPI:1508841024
Name:SOLOMON, RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 AVOCADO AVE
Mailing Address - Street 2:#608
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-640-2081
Mailing Address - Fax:949-640-1909
Practice Address - Street 1:1401 AVOCADO AVE
Practice Address - Street 2:#608
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-640-2081
Practice Address - Fax:949-640-1909
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57132174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG57132Medicare ID - Type Unspecified
C36137Medicare UPIN