Provider Demographics
NPI:1245064567
Name:SOLOMON, BERTINA (MED)
Entity type:Individual
Prefix:
First Name:BERTINA
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 LYNDON B JOHNSON FWY STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2055
Mailing Address - Country:US
Mailing Address - Phone:972-655-9780
Mailing Address - Fax:
Practice Address - Street 1:9101 LYNDON B JOHNSON FWY STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-2055
Practice Address - Country:US
Practice Address - Phone:972-655-9780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66061101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional