Provider Demographics
NPI:1255403085
Name:SOLOMON, OLIVER M (DO)
Entity type:Individual
Prefix:MR
First Name:OLIVER
Middle Name:M
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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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
Mailing Address - Country:US
Mailing Address - Phone:909-971-9334
Mailing Address - Fax:909-971-9654
Practice Address - Street 1:130 WEST ROUTE 66
Practice Address - Street 2:SUITE 326
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740
Practice Address - Country:US
Practice Address - Phone:626-963-8588
Practice Address - Fax:626-968-8578
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A7503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A7503OtherMEDICARE
CA00AX75030Medicaid
H49310Medicare UPIN
CA00AX75030Medicaid