Provider Demographics
NPI:1306087747
Name:SOLO, JEPH A (RNFA)
Entity type:Individual
Prefix:
First Name:JEPH
Middle Name:A
Last Name:SOLO
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 978
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CA
Mailing Address - Zip Code:95310-0978
Mailing Address - Country:US
Mailing Address - Phone:209-533-3838
Mailing Address - Fax:209-533-3838
Practice Address - Street 1:11833 BAXTER QUARRY ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:CA
Practice Address - Zip Code:95310-0978
Practice Address - Country:US
Practice Address - Phone:209-533-3838
Practice Address - Fax:209-533-3838
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA577611174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist