Provider Demographics
NPI:1609895127
Name:SOLOMON, DANIEL MARTIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MARTIN
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 10TH ST
Mailing Address - Street 2:SUITE#302
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2857
Mailing Address - Country:US
Mailing Address - Phone:310-395-6327
Mailing Address - Fax:310-458-9703
Practice Address - Street 1:1450 10TH ST
Practice Address - Street 2:SUITE#302
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2857
Practice Address - Country:US
Practice Address - Phone:310-395-6327
Practice Address - Fax:310-458-9703
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2020213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE2020Medicaid
CAE2020Medicaid
CAT19158Medicare UPIN