Provider Demographics
NPI:1255040952
Name:SOLOMON-MURPHY, BRYAN JACOB
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:JACOB
Last Name:SOLOMON-MURPHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 TY ST
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-5483
Mailing Address - Country:US
Mailing Address - Phone:408-605-3572
Mailing Address - Fax:
Practice Address - Street 1:1434 TY ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-5483
Practice Address - Country:US
Practice Address - Phone:408-605-3572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117682103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling