Provider Demographics
NPI:1568777126
Name:SOLANO FAMILY PHYSICIANS MEDICAL GROUP PROF CORP
Entity Type:Organization
Organization Name:SOLANO FAMILY PHYSICIANS MEDICAL GROUP PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-745-2705
Mailing Address - Street 1:1100 ROSE DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3623
Mailing Address - Country:US
Mailing Address - Phone:707-745-2705
Mailing Address - Fax:
Practice Address - Street 1:1100 ROSE DR
Practice Address - Street 2:SUITE 140
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3623
Practice Address - Country:US
Practice Address - Phone:707-745-2705
Practice Address - Fax:707-745-1902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A0627550261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care