Basic Information
| Provider Information | |||||||||
| NPI: | 1295001667 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SOLANO | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | JACOB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2815 SOUTH SEACREST BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33401 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 DEACONESS RD | ||||||||
| Address2: | WEST CLINICAL CENTER 2 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177542339 | ||||||||
| FaxNumber: | 6177542350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2012 | ||||||||
| LastUpdateDate: | 08/04/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 252299 | MA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 130502 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.