Basic Information
| Provider Information | |||||||||
| NPI: | 1083832166 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOLOMON | ||||||||
| FirstName: | JOETTA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8151 ARLINGTON AVE | ||||||||
| Address2: | SUITES U-V | ||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925030436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9515880861 | ||||||||
| FaxNumber: | 9515881910 | ||||||||
| Practice Location | |||||||||
| Address1: | 7117 BROCKTON AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925062658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516836370 | ||||||||
| FaxNumber: | 9517843269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 11/07/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 13188 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | ZZZ31887Z | 01 | CA | GROUP PTAN | OTHER | EAP70324F | 01 | CA | EAPC | OTHER | HAP71040F | 05 | CA | MEDICAID |