Provider Demographics
NPI:1609240126
Name:OLIVER M. SOLOMON, DO, INC
Entity Type:Organization
Organization Name:OLIVER M. SOLOMON, DO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-963-8588
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-0457
Mailing Address - Country:US
Mailing Address - Phone:909-971-9334
Mailing Address - Fax:909-575-3573
Practice Address - Street 1:130 W ROUTE 66 STE 326
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6252
Practice Address - Country:US
Practice Address - Phone:909-971-9334
Practice Address - Fax:909-575-3573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty