Provider Demographics
NPI:1750367587
Name:SOLL, MARK I (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:I
Last Name:SOLL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1400 E CHURCH ST
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5906
Mailing Address - Country:US
Mailing Address - Phone:805-739-3114
Mailing Address - Fax:805-739-3502
Practice Address - Street 1:1304 ELLA ST STE A
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4165
Practice Address - Country:US
Practice Address - Phone:805-549-9555
Practice Address - Fax:805-549-0444
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2023-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG62503207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA290012006OtherRAILROAD MEDICARE PIN
CA00G0625030Medicaid
E78295Medicare UPIN
CA290012006OtherRAILROAD MEDICARE PIN