Provider Demographics
NPI:1629141205
Name:SOLOMON, BRIAN HABTE
Entity Type:Individual
Prefix:MS
First Name:BRIAN
Middle Name:HABTE
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10503 S WESTERN AVE STE A D
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-4458
Mailing Address - Country:US
Mailing Address - Phone:323-757-1477
Mailing Address - Fax:323-757-1477
Practice Address - Street 1:10503 S WESTERN AVE STE A D
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-4458
Practice Address - Country:US
Practice Address - Phone:323-757-1477
Practice Address - Fax:323-757-1477
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor