Provider Demographics
NPI:1326448788
Name:SOLOMON, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25570 THE OLD RD # 1081
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1705
Mailing Address - Country:US
Mailing Address - Phone:818-336-1786
Mailing Address - Fax:
Practice Address - Street 1:16200 VENTURA BLVD STE 403
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4692
Practice Address - Country:US
Practice Address - Phone:818-336-1786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31720103TF0000X, 103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical