Provider Demographics
NPI:1194103796
Name:SOLANO CENTER OF EXCELLENCE MEDICAL CORP
Entity type:Organization
Organization Name:SOLANO CENTER OF EXCELLENCE MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAYNITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATALIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-551-3319
Mailing Address - Street 1:100 HOSPITAL DR STE 110
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2577
Mailing Address - Country:US
Mailing Address - Phone:707-551-3300
Mailing Address - Fax:
Practice Address - Street 1:1760 TUOLUMNE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2619
Practice Address - Country:US
Practice Address - Phone:707-551-3360
Practice Address - Fax:707-643-3018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty