Provider Demographics
NPI:1952380834
Name:SOLANO, JOEL M (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:M
Last Name:SOLANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E CALIFORNIA BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3205
Mailing Address - Country:US
Mailing Address - Phone:626-269-5357
Mailing Address - Fax:
Practice Address - Street 1:44139 MONTEREY AVE
Practice Address - Street 2:A
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-8700
Practice Address - Country:US
Practice Address - Phone:760-779-0800
Practice Address - Fax:760-779-0801
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48053207W00000X
CAC146976207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN340033600Medicaid
I42572Medicare UPIN
MN340033600Medicaid