Provider Demographics
NPI:1578069829
Name:SOLOMON, KRISTINE (CNC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 MIRA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1506
Mailing Address - Country:US
Mailing Address - Phone:562-631-8726
Mailing Address - Fax:
Practice Address - Street 1:2232 MIRA VISTA AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1506
Practice Address - Country:US
Practice Address - Phone:562-631-8726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2505133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty