Provider Demographics
NPI:1578722302
Name:SOLARI, IAN L (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:L
Last Name:SOLARI
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:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:866-681-0736
Mailing Address - Fax:
Practice Address - Street 1:11795 EDUCATION ST STE 201
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2469
Practice Address - Country:US
Practice Address - Phone:530-889-7470
Practice Address - Fax:530-889-7471
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126399207P00000X, 207QS0010X
VA0101248329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1578722302Medicaid
CAA126399Medicaid
VA1578722302Medicaid
CAA126399Medicaid